Provider Demographics
NPI:1952765596
Name:STEPS FOR CHANGE BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:STEPS FOR CHANGE BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-302-0801
Mailing Address - Street 1:634 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3603
Mailing Address - Country:US
Mailing Address - Phone:407-912-4574
Mailing Address - Fax:336-824-1737
Practice Address - Street 1:634 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3603
Practice Address - Country:US
Practice Address - Phone:407-912-4574
Practice Address - Fax:336-824-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-10
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 251B00000X
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLATN620797Medicaid
FLATN620799Medicaid