Provider Demographics
NPI:1306646559
Name:CHANGE UP BEHAVIORAL SERVICES, LLC.
Entity type:Organization
Organization Name:CHANGE UP BEHAVIORAL SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:540-598-9512
Mailing Address - Street 1:626 WOODS AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4828
Mailing Address - Country:US
Mailing Address - Phone:541-598-9512
Mailing Address - Fax:540-301-5821
Practice Address - Street 1:2408 ELECTRIC RD STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3523
Practice Address - Country:US
Practice Address - Phone:336-986-4276
Practice Address - Fax:540-301-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health