MEDICARE: BE THE CHANGE THERAPEUTIC SERVICES 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1356075576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BE THE CHANGE THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	1601-1 N MAIN ST UNIT 3159
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-7707
Country	:	US
Telephone Number	:	941-315-8433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601-1 N MAIN ST UNIT 3159
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-7707
Country	:	US
Telephone Number	:	941-315-8433
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	AMANDA PRICE
Credential	:	LCSW, LISW-S
Telephone Number	:	740-262-8710

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	10/22/2025

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