Provider Demographics
NPI:1477115384
Name:ONE CHANGE GROUP INC
Entity type:Organization
Organization Name:ONE CHANGE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-304-5499
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-1121
Mailing Address - Country:US
Mailing Address - Phone:208-304-5499
Mailing Address - Fax:855-978-1004
Practice Address - Street 1:710 W SUPERIOR ST STE C
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1684
Practice Address - Country:US
Practice Address - Phone:208-304-5499
Practice Address - Fax:855-978-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID013592Medicaid