NPIMap

Organization Active NPI

Tides of Change Center of Wellness

  • Community/Behavioral Health Agency
  • Sierra Vista, AZ
National Provider Identifier
1376869321
Registry record updated Apr 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
LCSW10948 Issued in AZ
Legal business name
TIDES OF CHANGE CENTER OF WELLNESS
Practice address
1451 E Redrock Dr
Sierra Vista, AZ 85650-8499
Phone
(520) 249-7650
NPI assigned
Apr 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2010

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

Authorized official

Name
Marianne S Valladares, LCSW
Title
President
Phone
(520) 249-7650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X LCSW10948 AZ Primary

Addresses

Primary practice location

1451 E Redrock Dr
Sierra Vista, AZ 85650-8499

Mailing address

1451 E Redrock Dr
Sierra Vista, AZ 85650-8499
Phone (520) 249-7650

National Provider Directory

National Provider Directory
Tax ID family
Tides of Change2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271289600000",
    "number": "1376869321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 E REDROCK DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856508499",
            "telephone_number": "520-249-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 E REDROCK DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856508499",
            "telephone_number": "520-249-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDES OF CHANGE CENTER OF WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-15",
        "last_updated": "2010-04-15",
        "status": "A",
        "authorized_official_last_name": "VALLADARES",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "520-249-7650",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "LCSW10948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.