Healthcare Provider Details

I. General information

NPI: 1013801117
Provider Name (Legal Business Name): SEASONS OF CHANGE LICENSED CLINICAL SOCIAL WORKER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20288 W VALLEY BLVD
TEHACHAPI CA
93561-8614
US

IV. Provider business mailing address

20288 W VALLEY BLVD
TEHACHAPI CA
93561-8614
US

V. Phone/Fax

Practice location:
  • Phone: 760-428-2776
  • Fax: 760-560-2079
Mailing address:
  • Phone: 760-428-2776
  • Fax: 760-560-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA L STOCKER
Title or Position: OWNER
Credential: LCSW
Phone: 760-428-2776