Provider Demographics
NPI:1356044150
Name:CHANGEPOINT INTEGRATED HEALTH
Entity type:Organization
Organization Name:CHANGEPOINT INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-5315
Mailing Address - Street 1:1801 W DEUCE OF CLUBS STE 100
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-2704
Mailing Address - Country:US
Mailing Address - Phone:520-428-1900
Mailing Address - Fax:
Practice Address - Street 1:2931 HWY 260
Practice Address - Street 2:
Practice Address - City:OVERGAARD
Practice Address - State:AZ
Practice Address - Zip Code:85933-8590
Practice Address - Country:US
Practice Address - Phone:928-965-2832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)