Healthcare Provider Details

I. General information

NPI: 1285577791
Provider Name (Legal Business Name): POSITIVE CHANGE BEHAVIORAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 ROUSS COURT
BLUE LAKE CA
95525-0705
US

IV. Provider business mailing address

PO BOX 705
BLUE LAKE CA
95525-0705
US

V. Phone/Fax

Practice location:
  • Phone: 707-499-0736
  • Fax: 707-630-3780
Mailing address:
  • Phone: 707-499-0736
  • Fax: 707-630-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CELIA M DRILL
Title or Position: OWNER
Credential: BCBA
Phone: 707-499-0736