Healthcare Provider Details

I. General information

NPI: 1225660608
Provider Name (Legal Business Name): GREATER CHANGES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N CENTRAL AVE STE 1007
OVIEDO FL
32765-7423
US

IV. Provider business mailing address

629 PINEBRANCH CIR
WINTER SPRINGS FL
32708-5642
US

V. Phone/Fax

Practice location:
  • Phone: 407-454-7343
  • Fax:
Mailing address:
  • Phone: 407-454-7343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMARA MOHAMMED
Title or Position: MANAGER
Credential: LMHC, NCC
Phone: 407-454-7343