| Waychangers Services Llc | |
|
710 Oak Field Dr Suite 153 Brendon FL 33511 | |
| (866) 472-7075 | |
| (866) 472-9754 |
| Full Name | Waychangers Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 710 Oak Field Dr, Brendon, Florida |
| Authorized Official Name and Position | Claiborne J Christian (OWNER/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8137311795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waychangers Services Llc 3210 Thackery Way Plant City FL 33566 Ph: (813) 731-1975 | Waychangers Services Llc 710 Oak Field Dr Suite 153 Brendon FL 33511 Ph: (866) 472-7075 |
| NPI Number | 1093017055 |
|---|---|
| Provider Enumeration Date | 11/24/2010 |
| Last Update Date | 09/15/2021 |
| Certification Date | 09/15/2021 |
| Medicare PECOS PAC ID | 4981042322 |
|---|---|
| Medicare Enrollment ID | O20240404002556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093017055 | NPI | - | NPPES |
| 766129100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | MH9398 (Florida) | Secondary |
| Provider Name | Kristina Deveau |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376298406 PECOS PAC ID: 1456797539 Enrollment ID: I20240312000498 |
| Provider Name | Theresa Lyvette Lewis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992270953 PECOS PAC ID: 4385086636 Enrollment ID: I20240531001732 |