| Sea Change, Llc | |
|
8160 E Butherus Dr Ste 5 Scottsdale AZ 85260-2523 | |
| (480) 390-1409 | |
| (480) 383-6825 |
| Full Name | Sea Change, Llc |
|---|---|
| Speciality | Counselor |
| Location | 8160 E Butherus Dr Ste 5, Scottsdale, Arizona |
| Authorized Official Name and Position | Kimberly Anne Popkey (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 4803901409 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sea Change, Llc 8160 E Butherus Dr Ste 5 Scottsdale AZ 85260-2523 Ph: (480) 390-1409 | Sea Change, Llc 8160 E Butherus Dr Ste 5 Scottsdale AZ 85260-2523 Ph: (480) 390-1409 |
| NPI Number | 1043969173 |
|---|---|
| Provider Enumeration Date | 03/23/2022 |
| Last Update Date | 03/23/2022 |
| Certification Date | 03/23/2022 |
| Medicare PECOS PAC ID | 7416300363 |
|---|---|
| Medicare Enrollment ID | O20240127000423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043969173 | NPI | - | NPPES |
| 884628 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Kimberly Anne Popkey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578660825 PECOS PAC ID: 8325491277 Enrollment ID: I20240127000434 |
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