Provider Demographics
NPI:1316317043
Name:CHANGE TALK PLLC
Entity type:Organization
Organization Name:CHANGE TALK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHN-FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:802-299-7895
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:VT
Mailing Address - Zip Code:05088
Mailing Address - Country:US
Mailing Address - Phone:802-299-7895
Mailing Address - Fax:
Practice Address - Street 1:2458 CHRISTIAN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001
Practice Address - Country:US
Practice Address - Phone:802-299-7895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty