Provider Demographics
NPI:1194410712
Name:POSITIVE CHANGE BEHAVIORAL, INC.
Entity type:Organization
Organization Name:POSITIVE CHANGE BEHAVIORAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DRILL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:707-499-0736
Mailing Address - Street 1:5501 DUNSMUIR AVE
Mailing Address - Street 2:
Mailing Address - City:DUNSMUIR
Mailing Address - State:CA
Mailing Address - Zip Code:96025-2013
Mailing Address - Country:US
Mailing Address - Phone:170-749-9073
Mailing Address - Fax:707-630-3780
Practice Address - Street 1:241 COUNTY ROAD 285
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-6730
Practice Address - Country:US
Practice Address - Phone:707-499-0736
Practice Address - Fax:707-630-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty