Provider Demographics
NPI:1497126858
Name:CHAT & CHANGE
Entity type:Organization
Organization Name:CHAT & CHANGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-368-8228
Mailing Address - Street 1:1212 OAKRIDGE DR
Mailing Address - Street 2:P.O. BOX 301
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1540
Mailing Address - Country:US
Mailing Address - Phone:801-657-1581
Mailing Address - Fax:801-747-6858
Practice Address - Street 1:835 E 4800 S STE 220
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5533
Practice Address - Country:US
Practice Address - Phone:385-368-8229
Practice Address - Fax:801-747-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========OtherTAX ID