Provider Demographics
NPI:1427463694
Name:CHANGE OF THOUGHT INTERGRATED HEALTH SOLUTIONS
Entity type:Organization
Organization Name:CHANGE OF THOUGHT INTERGRATED HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:575-649-5898
Mailing Address - Street 1:205 W BOUTZ RD BLDG 4
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3259
Mailing Address - Country:US
Mailing Address - Phone:575-649-5898
Mailing Address - Fax:575-652-4555
Practice Address - Street 1:205 W BOUTZ RD BLDG 4
Practice Address - Street 2:SUITE 3
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3259
Practice Address - Country:US
Practice Address - Phone:575-649-5898
Practice Address - Fax:575-652-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM126831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty