Healthcare Provider Details

I. General information

NPI: 1881468932
Provider Name (Legal Business Name): CHANGING THE CYCLE 2 LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E PALMDALE BLVD STE 14
PALMDALE CA
93550-2019
US

IV. Provider business mailing address

1311 E PALMDALE BLVD STE 14
PALMDALE CA
93550-2019
US

V. Phone/Fax

Practice location:
  • Phone: 661-228-0567
  • Fax: 619-241-2678
Mailing address:
  • Phone: 661-228-0567
  • Fax: 619-241-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID RICHARDS
Title or Position: CEO
Credential: LCSW
Phone: 661-228-0567