Provider Demographics
NPI:1053541102
Name:21DAYS2CHANGE, LLC
Entity type:Organization
Organization Name:21DAYS2CHANGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-816-7735
Mailing Address - Street 1:PO BOX 57366
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-7366
Mailing Address - Country:US
Mailing Address - Phone:405-816-7735
Mailing Address - Fax:405-286-1380
Practice Address - Street 1:12032 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7827
Practice Address - Country:US
Practice Address - Phone:405-816-7735
Practice Address - Fax:405-286-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherEIN