Basic Information
| Provider Information | |||||||||
| NPI: | 1831446012 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THINKCHANGE INTERVENTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | SULPHUR | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706633423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375286969 | ||||||||
| FaxNumber: | 3375286970 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | SULPHUR | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706633423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375286969 | ||||||||
| FaxNumber: | 3375286970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | LANE | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3375286969 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7327 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.