Healthcare Provider Details

I. General information

NPI: 1043175599
Provider Name (Legal Business Name): CHANGE IS AN ADVENTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 N STATE ROAD 7 STE 311
LAUDERDALE LAKES FL
33319-4871
US

IV. Provider business mailing address

6200 NW 44TH ST APT 415
LAUDERHILL FL
33319-4428
US

V. Phone/Fax

Practice location:
  • Phone: 786-525-4267
  • Fax:
Mailing address:
  • Phone: 786-525-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PABLO URIARTE
Title or Position: CLINICAL SUPERVISOR
Credential: LCSW
Phone: 954-394-3095