Healthcare Provider Details

I. General information

NPI: 1124659206
Provider Name (Legal Business Name): OASIS FOR CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 ROSS DR APT U9
FORT COLLINS CO
80526-6606
US

IV. Provider business mailing address

3205 COLONY CLUB RD APT 2
POMPANO BEACH FL
33062-4728
US

V. Phone/Fax

Practice location:
  • Phone: 970-541-9534
  • Fax:
Mailing address:
  • Phone: 970-541-9534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: NATHAN PRESTON
Title or Position: CEO
Credential: LMFT
Phone: 970-541-9534