MEDICARE: CENTER 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

General Provider Information

NPI Number	:	1194266858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR CHANGE

Provider Business Mailing Address
First Line	:	3311 S RAINBOW BLVD
Second Line	:	108
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 S RAINBOW BLVD
Second Line	:	108
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6206
Country	:	US
Telephone Number	:	702-901-2583
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARET ONEILL
Credential	:	LCSW
Telephone Number	:	702-901-2583

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/15/2017

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Directions to “CENTER FOR CHANGE ” Practice Location

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