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General NPI Number Information
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NPI Number | 1427702588
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Entity Type | Organization
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Legal Business Name | CHANGE, LLC
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 6692 E VIA JARDIN VERDE
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City | TUCSON
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State | AZ
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Zip | 85756-0022
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Country | US
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Telephone | 623-632-9586
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Fax |
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Provider Business Mailing Address
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Address Line | 6692 E VIA JARDIN VERDE
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City | TUCSON
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State | AZ
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Zip | 85756-0022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/LEAD CLINICAL THERAPIST
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Name | DR. TIFFANY RUELAZ
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Credential | PHD, LPC
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Telephone | 520-276-6893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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