| Center For Positive Change Llc | |
|
1136 Water St Ste 105 Port Townsend WA 98368-6728 | |
| (360) 385-1030 | |
| (775) 243-9945 |
| Full Name | Center For Positive Change Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1136 Water St Ste 105, Port Townsend, Washington |
| Authorized Official Name and Position | Timothy David Berry (PRESIDENT) |
| Authorized Official Contact | 3603851030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Positive Change Llc 1136 Water St Ste 105 Port Townsend WA 98368-6728 Ph: (360) 385-1030 | Center For Positive Change Llc 1136 Water St Ste 105 Port Townsend WA 98368-6728 Ph: (360) 385-1030 |
| NPI Number | 1063982247 |
|---|---|
| Provider Enumeration Date | 11/29/2018 |
| Last Update Date | 11/29/2018 |
| Medicare PECOS PAC ID | 1850727264 |
|---|---|
| Medicare Enrollment ID | O20200203002440 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063982247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Timothy D Berry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972623411 PECOS PAC ID: 6800822024 Enrollment ID: I20200204000458 |
| Provider Name | Autumn L. Berry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922864446 PECOS PAC ID: 5294174835 Enrollment ID: I20240416002610 |
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