Healthcare Provider Details

I. General information

NPI: 1477115384
Provider Name (Legal Business Name): ONE CHANGE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W SUPERIOR ST STE C
SANDPOINT ID
83864-1684
US

IV. Provider business mailing address

PO BOX 1121
SAGLE ID
83860-1121
US

V. Phone/Fax

Practice location:
  • Phone: 208-304-5499
  • Fax: 855-978-1004
Mailing address:
  • Phone: 208-304-5499
  • Fax: 855-978-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY TOPP
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 208-304-5499