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General NPI Number Information
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NPI Number | 1407035918
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Entity Type | Organization
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Legal Business Name | CHANGE LANES YOUTH SUPPORT SERVICES
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 45118 13TH ST W
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City | LANCASTER
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State | CA
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Zip | 93534-2156
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Country | US
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Telephone | 661-948-5555
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Fax | 661-878-9130
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Provider Business Mailing Address
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Address Line | 45118 13TH STREET WEST UNIT 1D
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City | LANCASTER
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State | CA
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Zip | 93534-2156
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Country | US
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Telephone | 661-948-2555
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Fax | 661-878-9130
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CYNTHIA D. HUNTER-SPEARS
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Credential | MA, CATC
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Telephone | 661-948-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 10007140
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 10023326
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License Number State | CA
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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 | 10007140
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License Number State | CA
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