MEDICARE: STRATEGIES FOR CHANGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	340084BN	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033515028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRATEGIES FOR CHANGE

Provider Business Mailing Address
First Line	:	4441 AUBURN BLVD STE E
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-4139
Country	:	US
Telephone Number	:	916-473-5764
Fax Number	:	916-473-5766

Provider Business Practice Location Address
First Line	:	2250 JOHN STILL DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95832-1331
Country	:	US
Telephone Number	:	916-395-3552
Fax Number	:	916-473-5766

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BJ DAVIS
Credential	:	PSYD
Telephone Number	:	916-395-3552

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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Directions to “STRATEGIES FOR CHANGE ” Practice Location

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