Basic Information
| Provider Information | |||||||||
| NPI: | 1568984300 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHANGES PREMIER HEALTH , LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 N LAKE FOREST DR | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750717665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696341270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1820 N LAKE FOREST DRIVE | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177692056 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2017 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | SCHUTTE | ||||||||
| AuthorizedOfficialFirstName: | ROCHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4696341277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.