Provider Demographics
NPI:1871229708
Name:CHANG THERAPIES LLC
Entity type:Organization
Organization Name:CHANG THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TINGLE CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:662-255-7818
Mailing Address - Street 1:44 PINE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5151
Mailing Address - Country:US
Mailing Address - Phone:662-255-7818
Mailing Address - Fax:
Practice Address - Street 1:44 PINE MANOR DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5151
Practice Address - Country:US
Practice Address - Phone:662-255-7818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1841762846Medicaid