Healthcare Provider Details

I. General information

NPI: 1427702588
Provider Name (Legal Business Name): CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6692 E VIA JARDIN VERDE
TUCSON AZ
85756-0022
US

IV. Provider business mailing address

6692 E VIA JARDIN VERDE
TUCSON AZ
85756-0022
US

V. Phone/Fax

Practice location:
  • Phone: 623-632-9586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TIFFANY RUELAZ
Title or Position: CEO/LEAD CLINICAL THERAPIST
Credential: PHD, LPC
Phone: 520-276-6893