Provider Demographics
NPI:1649913369
Name:CHANGING TIDES THERAPY, LLC
Entity type:Organization
Organization Name:CHANGING TIDES THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRIMARY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCGINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:609-365-0205
Mailing Address - Street 1:601 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210
Mailing Address - Country:US
Mailing Address - Phone:609-365-0205
Mailing Address - Fax:
Practice Address - Street 1:601 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210
Practice Address - Country:US
Practice Address - Phone:609-365-0205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty