| Change Therapeutic Services, Inc. | |
|
15447 Anacapa Rd Ste D102 Victorville CA 92392-2481 | |
| (090) 965-4079 | |
| (800) 915-8151 |
| Full Name | Change Therapeutic Services, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 15447 Anacapa Rd Ste D102, Victorville, California |
| Authorized Official Name and Position | Shareela Marie Allen (OWNER) |
| Authorized Official Contact | 9096540798 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Therapeutic Services, Inc. 15447 Anacapa Rd Ste D102 Victorville CA 92392-2481 Ph: (909) 654-0798 | Change Therapeutic Services, Inc. 15447 Anacapa Rd Ste D102 Victorville CA 92392-2481 Ph: (090) 965-4079 |
| NPI Number | 1134718042 |
|---|---|
| Provider Enumeration Date | 01/14/2021 |
| Last Update Date | 01/14/2021 |
| Certification Date | 01/14/2021 |
| Medicare PECOS PAC ID | 3072914746 |
|---|---|
| Medicare Enrollment ID | O20210701002264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134718042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
| Provider Name | Shareela M Allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578793337 PECOS PAC ID: 4284964073 Enrollment ID: I20190920000966 |
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