Healthcare Provider Details

I. General information

NPI: 1043762883
Provider Name (Legal Business Name): CHANGING FACES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 ODIE LN
SANTA MARIA CA
93455-3109
US

IV. Provider business mailing address

4124 ODIE LN
SANTA MARIA CA
93455-3109
US

V. Phone/Fax

Practice location:
  • Phone: 805-938-0125
  • Fax:
Mailing address:
  • Phone: 805-938-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE N. COOKS
Title or Position: HR DIRECTOR
Credential:
Phone: 805-937-5475