Provider Demographics
NPI:1952343444
Name:CHANGEPOINT INTEGRATED
Entity type:Organization
Organization Name:CHANGEPOINT INTEGRATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:928-537-2951
Mailing Address - Street 1:1801 W DEUCE OF CLUBS
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-2705
Mailing Address - Country:US
Mailing Address - Phone:928-537-2951
Mailing Address - Fax:928-892-5828
Practice Address - Street 1:2500 E SHOW LOW LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7994
Practice Address - Country:US
Practice Address - Phone:928-537-2951
Practice Address - Fax:928-892-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOCT6054261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007460OtherAHCCCS