Healthcare Provider Details

I. General information

NPI: 1003207002
Provider Name (Legal Business Name): CHANGE WITHIN REACH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 VENTURA BLVD STE 105
ENCINO CA
91316
US

IV. Provider business mailing address

17777 VENTURA BLVD STE 105
ENCINO CA
91316-3738
US

V. Phone/Fax

Practice location:
  • Phone: 213-445-2266
  • Fax: 213-908-1233
Mailing address:
  • Phone: 213-445-2266
  • Fax: 213-908-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLCSW28777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ANNA GERSHELIS
Title or Position: PRESIDENT
Credential:
Phone: 213-445-2266