Changing Phases Behavioral Support

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL-041-794 Issued in NC

Legal business name

CHANGING PHASES BEHAVIORAL SUPPORT

Practice address

1609 Clemmons St
Greensboro, NC 27406-2870

Phone

(336) 333-2542

Fax

(336) 333-2858

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Quinten Cullins

Title

Program Director

Phone

(336) 333-2542

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• Changing Phases Behavioral Support One Doing business as

Locations

Practitioners 1

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

• Mya S Cullins, MS, LCASA

  • Mental Health Counselor
  • Greensboro, NC
  • NPI 1790038685
  NPD (past)

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331510400000",
    "number": "1811057045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 N ELM ST",
            "address_2": "SUITE 215",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274012177",
            "telephone_number": "336-333-2542",
            "fax_number": "336-333-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 CLEMMONS ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274062870",
            "telephone_number": "336-333-2542",
            "fax_number": "336-333-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGING PHASES BEHAVIORAL SUPPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2012-03-12",
        "status": "A",
        "authorized_official_last_name": "CULLINS",
        "authorized_official_first_name": "QUINTEN",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "336-333-2542",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-041-794",
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-041-894",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604413",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301765",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006908",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301765G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Changing Phases Behavioral Support One",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Change Point Consultants, PLLC
• Change Therapeutic Services PLLC
• Changing Lives Group Home II LLC
• Changing Lives Group Home IV , LLC
• Changing Paths Counseling Center PLLC
• Grace Faith Chao, M.D.
• Alexander Clayton Chapman
• Katherine Elizabeth Chapman, NP
• Marissa Danielle Chappell, M.S. CCC-SLP
• McKenzie Chappell

• Emotionally Disturbed Childrens' Residential Treatment Facility in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; 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.