Collaborative Change LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34005850A Issued in IN

Legal business name

COLLABORATIVE CHANGE LLC

Practice address

1060 E Main St # S401
Brownsburg, IN 46112-1408

Phone

(317) 296-4187

Fax

(317) 203-0995

NPI assigned

Aug 15, 2013

Organization subpart

No

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

Authorized official

Name

Babe Black, LCSWNPI 1114145513

Title

Owner

Phone

(317) 225-9483

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 2

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

• Babe Black, LCSW

  • Clinical Social Worker
  • Indianapolis, IN
  • NPI 1114145513
  Medicare reassignment Authorized official
• Alyssa Bevlynn Burton

  • Mental Health Counselor
  • Indianapolis, IN
  • NPI 1780224220
  NPD (past)

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

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1770916587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8331 CRAWFORDSVILLE RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462347740",
            "telephone_number": "317-296-4187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 E MAIN ST # S401",
            "city": "BROWNSBURG",
            "state": "IN",
            "postal_code": "461121408",
            "telephone_number": "317-296-4187",
            "fax_number": "317-203-0995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10787 Running Brook Rd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462347740",
            "country_code": "US",
            "telephone_number": "317-225-9483",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1125 Brookside Ave Ste S60",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462020056",
            "country_code": "US",
            "telephone_number": "317-296-4187",
            "fax_number": "317-203-0995",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10293 N Meridian St # S180",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "462901123",
            "country_code": "US",
            "telephone_number": "317-296-4187",
            "fax_number": "317-203-0995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COLLABORATIVE CHANGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-15",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "BABE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-225-9483",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005850A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20119194A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Coffey
• Karrington Cole, RBT
• Mary Cole
• Ja'Nay Coleman, RBT
• Jalin Coleman, RBT
• Karla Colmenares-Avila, RBT
• Community Health Network Rehabilitation Hospital West, LLC
• Compass Counseling and Therapeutic Services
• Christopher James Compton, MS, LAT, ATC
• Tayler Conn

• Clinical Social Worker in Brownsburg, IN
• Providers in Brownsburg, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; 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.