=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962398891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METACHANGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 5TH ST STE C
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50265-4733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-494-2797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4425 MILLS CIVIC PKWY UNIT 701
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50265-5451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-494-2797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | CHRISTOPHER T SHARPE
-----------------------------------------------------
Credential | LISW
-----------------------------------------------------
Telephone | 515-494-2797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------