Provider Demographics
NPI:1821969809
Name:POSITIVE CHANGE PSYCHIATRY & THERAPY SOLUTIONS LLC
Entity type:Organization
Organization Name:POSITIVE CHANGE PSYCHIATRY & THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:THEIS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:319-961-0696
Mailing Address - Street 1:325 21ST ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2043
Mailing Address - Country:US
Mailing Address - Phone:319-961-0696
Mailing Address - Fax:
Practice Address - Street 1:325 21ST ST NW STE A
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2043
Practice Address - Country:US
Practice Address - Phone:319-961-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty