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General NPI Number Information
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NPI Number | 1053701425
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Entity Type | Organization
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Legal Business Name | CHANGING TIDES TREATMENT LLC
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 2021 SPERRY AVE SUITE 3
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City | VENTURA
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State | CA
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Zip | 93003-7408
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Country | US
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Telephone | 844-883-3869
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 SEABREEZE WAY
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City | OXNARD
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State | CA
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Zip | 93035-1048
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Country | US
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Telephone | 844-883-3869
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Fax | 805-624-5311
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Authorized Official
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Title or Position | CEO
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Name | BERKELEY BEAUDEAN DAINS
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Credential | CATC, CIP,BS
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Telephone | 805-506-1541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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