Healthcare Provider Details

I. General information

NPI: 1407181704
Provider Name (Legal Business Name): STRATEGIES FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12945 MARENGO ROAD
GALT CA
95632
US

IV. Provider business mailing address

4343 WILLIAMSBOURGH DR
SACRAMENTO CA
95823-2006
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-5764
  • Fax: 916-473-5766
Mailing address:
  • Phone: 916-473-5764
  • Fax: 916-473-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number340084AN
License Number StateCA

VIII. Authorized Official

Name: MRS. CYNTHIA KEETH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-473-5764