Provider Demographics
NPI:1992503924
Name:CENTER FOR BEHAVIORAL CHANGE
Entity type:Organization
Organization Name:CENTER FOR BEHAVIORAL CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REINARDY SPIRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:701-356-1047
Mailing Address - Street 1:1450 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8105
Mailing Address - Country:US
Mailing Address - Phone:701-356-1047
Mailing Address - Fax:701-356-1052
Practice Address - Street 1:1450 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8105
Practice Address - Country:US
Practice Address - Phone:701-356-1047
Practice Address - Fax:701-356-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center