Healthcare Provider Details

I. General information

NPI: 1194281303
Provider Name (Legal Business Name): RAPID CHANGE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S 10TH ST
DUNCAN OK
73533-5278
US

IV. Provider business mailing address

423 N 19TH ST
DUNCAN OK
73533-2348
US

V. Phone/Fax

Practice location:
  • Phone: 405-519-5243
  • Fax:
Mailing address:
  • Phone: 405-519-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL KENT EDWARDS II
Title or Position: OWNER
Credential: MS
Phone: 405-519-5243