Healthcare Provider Details

I. General information

NPI: 1194660621
Provider Name (Legal Business Name): POSITIVE CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 STONEY CREEK DR
FORT WAYNE IN
46825-4408
US

IV. Provider business mailing address

6131 STONEY CREEK DR
FORT WAYNE IN
46825-4408
US

V. Phone/Fax

Practice location:
  • Phone: 260-291-2856
  • Fax:
Mailing address:
  • Phone: 260-291-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NOEL OCHOA
Title or Position: THERAPIST
Credential: LMHC
Phone: 260-440-6486