MEDICARE: CHANGING CYCLES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PRC13986	DC
2	101YP2500X	Professional Counselor	LC2555	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265713705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING CYCLES, LLC

Provider Business Mailing Address
First Line	:	3475 LEONARDTOWN RD
Second Line	:	SUITE 206
City	:	WALDORF
State	:	MD
Zip	:	20601-3678
Country	:	US
Telephone Number	:	301-357-6605
Fax Number	:

Provider Business Practice Location Address
First Line	:	14460 OLD MILL RD
Second Line	:	SUITE 201
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3092
Country	:	US
Telephone Number	:	301-357-6605
Fax Number	:

Authorized Official
Title or Position	:	VICE-PRESIDENT AND COO
Name	:	DR. KEYONA SHANTRICE THOMAS-KELLY
Credential	:	PSY.D., MA, LCPC
Telephone Number	:	301-357-6605

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	03/15/2012

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Directions to “CHANGING CYCLES, LLC ” Practice Location

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