Active NPI
Changes Behavioral Health, LLC
- Community/Behavioral Health Agency
- Wynne, AR
National Provider Identifier
1114260486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- 5606C
- Legal business name
- CHANGES BEHAVIORAL HEALTH, LLC
- Practice address
- 204 Mississippi St S
Wynne, AR 72396-3025 - Phone
- (870) 208-8499
- NPI assigned
- Apr 4, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brian Dickson Shaw, LCSW
- Title
- Therapist
- Phone
- (901) 570-0556
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 5606C | AR | Primary |
Addresses
Primary practice location
204 Mississippi St S
Wynne, AR 72396-3025
Mailing address
204 Mississippi St S
Wynne, AR 72396-3025
Phone (870) 208-8499
Other practice location 1
750 Medel Marconi Rd
Marion, AR 72364
Phone (870) 208-8499
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150108001118 | AR | Part B Supplier - Clinic/Group Practice | 6103149653 |
Receives reassigned benefits from 24 practitioners Practice locations: Wynne, AR; Marion, AR |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2269763 | Changes Behavioral Health LLC | Certificate of waiver | Oct 2, 2026 |
National Provider Directory
National Provider DirectoryLocations
204 Mississippi St S
Wynne, AR 72396
Phone (870) 208-8499
Practitioners & affiliated clinicians
Practitioners 80
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365033600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1745452800000",
"number": "1114260486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 MISSISSIPPI ST S",
"city": "WYNNE",
"state": "AR",
"postal_code": "723963025",
"telephone_number": "870-208-8499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 MISSISSIPPI ST S",
"city": "WYNNE",
"state": "AR",
"postal_code": "723963025",
"telephone_number": "870-208-8499"
}
],
"practiceLocations": [
{
"address_1": "750 Medel Marconi Rd",
"address_purpose": "LOCATION",
"city": "Marion",
"state": "AR",
"postal_code": "72364",
"country_code": "US",
"telephone_number": "870-208-8499",
"fax_number": "870-208-8044",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "CHANGES BEHAVIORAL HEALTH, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-04-04",
"last_updated": "2025-04-24",
"certification_date": "2025-04-17",
"status": "A",
"authorized_official_last_name": "SHAW",
"authorized_official_first_name": "BRIAN",
"authorized_official_middle_name": "DICKSON",
"authorized_official_title_or_position": "THERAPIST",
"authorized_official_telephone_number": "901-570-0556",
"authorized_official_credential": "LCSW"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "AR",
"license": "5606C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wynne, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.