Seasons Of Change Therapeutic Services | |
122 S Green St Tehachapi CA 93561-1717 | |
(760) 428-2776 | |
Not Available |
Full Name | Seasons Of Change Therapeutic Services |
---|---|
Speciality | Clinic/Center |
Location | 122 S Green St, Tehachapi, California |
Authorized Official Name and Position | Andrea L Stocker (SOLE PROPRIETOR) |
Authorized Official Contact | 7604282776 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Seasons Of Change Therapeutic Services Po Box 2390 Tehachapi CA 93581-2390 Ph: (760) 428-2776 | Seasons Of Change Therapeutic Services 122 S Green St Tehachapi CA 93561-1717 Ph: (760) 428-2776 |
NPI Number | 1609595362 |
---|---|
Provider Enumeration Date | 08/25/2022 |
Last Update Date | 10/25/2022 |
Certification Date | 09/08/2022 |
Medicare PECOS PAC ID | 7517336084 |
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Medicare Enrollment ID | O20221206002024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609595362 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Provider Name | Andrea L Stocker |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1174924435 PECOS PAC ID: 6901231505 Enrollment ID: I20200108001015 |
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