Provider Demographics
NPI:1891871489
Name:POSITIVE CHANGES LLC
Entity type:Organization
Organization Name:POSITIVE CHANGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALLIETT-BOX
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:405-607-1717
Mailing Address - Street 1:744 SE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-4843
Mailing Address - Country:US
Mailing Address - Phone:405-636-1463
Mailing Address - Fax:405-635-8417
Practice Address - Street 1:301 NW 63RD ST STE 650
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7915
Practice Address - Country:US
Practice Address - Phone:405-607-1717
Practice Address - Fax:405-607-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200063170DMedicaid
422897OtherJCAHO
OK200063170FMedicaid
OK200063170AMedicaid
OK200063170EMedicaid