Healthcare Provider Details

I. General information

NPI: 1093017055
Provider Name (Legal Business Name): WAYCHANGERS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 OAK FIELD DR SUITE 153
BRENDON FL
33511
US

IV. Provider business mailing address

3210 THACKERY WAY
PLANT CITY FL
33566
US

V. Phone/Fax

Practice location:
  • Phone: 866-472-7075
  • Fax: 866-472-9754
Mailing address:
  • Phone: 813-731-1975
  • Fax: 866-472-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH9398
License Number StateFL

VIII. Authorized Official

Name: MR. CLAIBORNE J CHRISTIAN III
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: LMHC
Phone: 813-731-1795