Healthcare Provider Details

I. General information

NPI: 1891871489
Provider Name (Legal Business Name): POSITIVE CHANGES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NW 63RD ST STE 650
OKLAHOMA CITY OK
73116-7915
US

IV. Provider business mailing address

2701 S HARVEY AVE FL 2
OKLAHOMA CITY OK
73109-6726
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-1717
  • Fax: 405-607-3332
Mailing address:
  • Phone: 405-636-1463
  • Fax: 405-635-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURA CHRISTINE BALLIETT-BOX
Title or Position: CEO
Credential: LPC
Phone: 405-607-1717