MEDICARE: POSITIVE CHANGE BEHAVIORAL, INC.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1285577791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE CHANGE BEHAVIORAL, INC.

Provider Business Mailing Address
First Line	:	PO BOX 705
Second Line	:
City	:	BLUE LAKE
State	:	CA
Zip	:	95525-0705
Country	:	US
Telephone Number	:	707-499-0736
Fax Number	:	707-630-3780

Provider Business Practice Location Address
First Line	:	117 ROUSS COURT
Second Line	:
City	:	BLUE LAKE
State	:	CA
Zip	:	95525-0705
Country	:	US
Telephone Number	:	707-499-0736
Fax Number	:	707-630-3780

Authorized Official
Title or Position	:	OWNER
Name	:	CELIA M DRILL
Credential	:	BCBA
Telephone Number	:	707-499-0736

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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