Provider Demographics
NPI:1336530245
Name:POSITIVE CHANGE PSYCHOTHERAPY COUNSELING
Entity Type:Organization
Organization Name:POSITIVE CHANGE PSYCHOTHERAPY COUNSELING
Other - Org Name:COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:CHIME
Authorized Official - Last Name:ONYIA
Authorized Official - Suffix:
Authorized Official - Credentials:MHR,LPC
Authorized Official - Phone:817-492-7000
Mailing Address - Street 1:5601 BRIDGE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2384
Mailing Address - Country:US
Mailing Address - Phone:817-492-7000
Mailing Address - Fax:817-492-7001
Practice Address - Street 1:5601 BRIDGE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2384
Practice Address - Country:US
Practice Address - Phone:817-492-7000
Practice Address - Fax:817-492-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC251S00000X
TXLPC-UNDERSUPERVISON251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1891016721Medicaid