Healthcare Provider Details

I. General information

NPI: 1306449384
Provider Name (Legal Business Name): THE CHANGE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W STROOP RD
MORAINE OH
45439-2041
US

IV. Provider business mailing address

2400 W STROOP RD
MORAINE OH
45439-2041
US

V. Phone/Fax

Practice location:
  • Phone: 937-315-0030
  • Fax: 937-701-6901
Mailing address:
  • Phone: 937-315-0030
  • Fax: 937-701-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JEORGE L LOGAN
Title or Position: DIRECTOR
Credential: MSSA,LICDC,CPS-S
Phone: 937-303-6727