NPIMap

Organization Active NPI

Change Therapeutic Services, Inc.

  • Clinical Social Worker
  • Victorville, CA
National Provider Identifier
1134718042
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CHANGE THERAPEUTIC SERVICES, INC.
Practice address
15447 Anacapa Rd Ste D102
Victorville, CA 92392-2481
Phone
(090) 965-4079
Fax
(800) 915-8151
NPI assigned
Jan 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shareela Marie AllenNPI 1578793337
Title
Owner
Phone
(909) 654-0798

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X Primary
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

15447 Anacapa Rd Ste D102
Victorville, CA 92392-2481

Mailing address

15447 Anacapa Rd Ste D102
Victorville, CA 92392-2481
Phone (909) 654-0798

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210701002264 CA Part B Supplier - Clinic/Group Practice 3072914746 Receives reassigned benefits from 4 practitioners
Practice locations: Victorville, CA

National Provider Directory

National Provider Directory

Locations

15447 Anacapa Rd
Ste D102
Victorville, CA 92392
Phone (909) 654-0798

Practitioners & affiliated clinicians

Practitioners 4

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": "1610582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610582400000",
    "number": "1134718042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15447 ANACAPA RD STE D102",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922481",
            "telephone_number": "909-654-0798",
            "fax_number": "800-915-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15447 ANACAPA RD STE D102",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922481",
            "telephone_number": "090-965-4079",
            "fax_number": "800-915-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE THERAPEUTIC SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-14",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "SHAREELA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-654-0798"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.