Syde by Syde Changes LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SYDE BY SYDE CHANGES LLC

Practice address

490 W 23Rd Ave
Gary, IN 46407-3017

Phone

(219) 333-7619

NPI assigned

Nov 18, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Acquinnetta Doughty, LCACNPI 1710359781

Title

Ceo

Phone

(219) 333-7619

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.

• Acquinnetta Doughty

  • Addiction (Substance Use Disorder) Counselor
  • Gary, IN
  • NPI 1710359781
  NPD Authorized official

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

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1841957362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 W 23RD AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464073017",
            "telephone_number": "219-333-7619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 W 23RD AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464073017",
            "telephone_number": "219-333-7619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYDE BY SYDE CHANGES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-18",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "DOUGHTY",
        "authorized_official_first_name": "ACQUINNETTA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-333-7619",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Gary, IN
• Providers in Gary, IN by specialty
• Community/Behavioral Health Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.