MEDICARE: CHANGES COUNSELING CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	106H00000X	Marriage & Family Therapist
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	103T00000X	Psychologist
6	1041C0700X	Clinical Social Worker
7	363AM0700X	Medical Physician Assistant
8	363A00000X	Physician Assistant
9	103TC0700X	Clinical Psychologist
10	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1225344096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGES COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	3835 N FREEWAY BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1954
Country	:	US
Telephone Number	:	916-576-7893
Fax Number	:	916-277-9380

Provider Business Practice Location Address
First Line	:	2811 TRICOM ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9172
Country	:	US
Telephone Number	:	919-354-0840
Fax Number	:	855-420-6402

Authorized Official
Title or Position	:	MANAGER
Name	:	JASMINE SPAULDING
Credential	:
Telephone Number	:	916-576-7893

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	05/05/2026

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