Healthcare Provider Details

I. General information

NPI: 1083816086
Provider Name (Legal Business Name): CHANGES COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711 BURNET RD SUITE A-3
AUSTIN TX
78757-7043
US

IV. Provider business mailing address

8711 BURNET RD SUITE A-3
AUSTIN TX
78757-7043
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-0066
  • Fax: 512-459-0499
Mailing address:
  • Phone: 512-257-0066
  • Fax: 512-459-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1947A
License Number StateTX

VIII. Authorized Official

Name: MR. KIM R DEREMER
Title or Position: DIRECTOR
Credential:
Phone: 512-257-0066