MEDICARE: SOLUTIONS FOR CHANGE, LLC.

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

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	:	1124713268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLUTIONS FOR CHANGE, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 342
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-0342
Country	:	US
Telephone Number	:	662-441-0061
Fax Number	:	662-441-0614

Provider Business Practice Location Address
First Line	:	511 S DAVIS AVE
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-3924
Country	:	US
Telephone Number	:	662-441-0610
Fax Number	:	662-441-0614

Authorized Official
Title or Position	:	LICENSED CERTIFIED SOCIAL WORKER
Name	:	MS. TRAYCEEA RAY
Credential	:	LCSW
Telephone Number	:	662-588-0025

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/05/2023

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Directions to “SOLUTIONS FOR CHANGE, LLC. ” Practice Location

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