Provider Demographics
NPI:1740844968
Name:ADVOCATES FOR CHANGE FAMILY SERVICES, PLLC
Entity type:Organization
Organization Name:ADVOCATES FOR CHANGE FAMILY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, SOLE OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-615-2447
Mailing Address - Street 1:PO BOX 3202
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802
Mailing Address - Country:US
Mailing Address - Phone:405-615-2447
Mailing Address - Fax:405-432-5071
Practice Address - Street 1:610 N. BROADWAY AVE,
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6202
Practice Address - Country:US
Practice Address - Phone:405-615-2447
Practice Address - Fax:405-432-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200842400AMedicaid