Basic Information
| Provider Information | |||||||||
| NPI: | 1902103617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHANGING BEHAVIOR SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7875 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711377875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186750224 | ||||||||
| FaxNumber: | 3186750226 | ||||||||
| Practice Location | |||||||||
| Address1: | 1434 HAWN AVE | ||||||||
| Address2: | STE. 12 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711076508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186750224 | ||||||||
| FaxNumber: | 3186750226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2011 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3186175869 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 251S00000X | 10111532#MVA42 | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.