Provider Demographics
NPI:1104804988
Name:H2CHANGE LLC
Entity type:Organization
Organization Name:H2CHANGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-417-2055
Mailing Address - Street 1:1865 PASEO SAN LUIS
Mailing Address - Street 2:STE B
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-417-2055
Mailing Address - Fax:520-417-2055
Practice Address - Street 1:1865 PASEO SAN LUIS
Practice Address - Street 2:STE B
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-417-2055
Practice Address - Fax:520-417-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3296103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ500505Medicaid
61827Medicare ID - Type Unspecified