Provider Demographics
NPI:1902103617
Name:CHANGING BEHAVIOR SERVICES, LLC
Entity Type:Organization
Organization Name:CHANGING BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:318-617-5869
Mailing Address - Street 1:PO BOX 7875
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71137-7875
Mailing Address - Country:US
Mailing Address - Phone:318-675-0224
Mailing Address - Fax:318-675-0226
Practice Address - Street 1:1434 HAWN AVE
Practice Address - Street 2:STE. 12
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6508
Practice Address - Country:US
Practice Address - Phone:318-675-0224
Practice Address - Fax:318-675-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10111532#MVA42251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health