Healthcare Provider Details

I. General information

NPI: 1104804988
Provider Name (Legal Business Name): H2CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 PASEO SAN LUIS STE B
SIERRA VISTA AZ
85635
US

IV. Provider business mailing address

1865 PASEO SAN LUIS STE B
SIERRA VISTA AZ
85635
US

V. Phone/Fax

Practice location:
  • Phone: 520-417-2055
  • Fax: 520-417-2055
Mailing address:
  • Phone: 520-417-2055
  • Fax: 520-417-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3296
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3296
License Number StateAZ

VIII. Authorized Official

Name: MS. TONI MARIE LEO
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 520-417-2055