Constructive Changes Licensed Clinical Social Worker Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CONSTRUCTIVE CHANGES LICENSED CLINICAL SOCIAL WORKER SERVICES

Practice address

44 E Main St Ste 406
Champaign, IL 61820-3649

Phone

(217) 615-0350

NPI assigned

Aug 14, 2023

Organization subpart

No

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

Authorized official

Name

Alex QuintanillaNPI 1568635613

Title

Owner

Phone

(217) 615-0350

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alex Balmore Quintanilla, LCSW 84870

  • Clinical Social Worker
  • Champaign, IL
  • NPI 1568635613
  NPD Authorized official

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1417630757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 W KIRBY AVE UNIT 306",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215507",
            "telephone_number": "217-615-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 E MAIN ST STE 406",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203649",
            "telephone_number": "217-615-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSTRUCTIVE CHANGES LICENSED CLINICAL SOCIAL WORKER SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-07-14",
        "status": "A",
        "authorized_official_last_name": "QUINTANILLA",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-615-0350"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Ann Comstock, APRN
• Confidentially Yours, Inc
• Madison L Conklen
• David P Conner, MD
• Tracy Conroy
• Alicia Cook, LPC
• Ashley Cook, RBT
• Tara L Cook, LCSW
• Kahlilah Cooke, RN, BS, CLC
• Gabriele D Cooper, LSW

• Community/Behavioral Health Agency in Champaign, IL
• Providers in Champaign, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.