Organization
CHANGE AGENTS OF SOCIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JADEN HINES (ADMINISTRATOR)
(702) 305-0652
Entity
Organization
Contact information
Practice address
4717 E MCDOWELL RD, PHOENIX, AZ 85008-4544
(702) 305-0562
Mailing address
4717 E MCDOWELL RD, PHOENIX, AZ 85008-4544
(702) 305-0562
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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