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General NPI Number Information
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NPI Number | 1023858727
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Entity Type | Organization
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Legal Business Name | THE CHANGE LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 12125 HIGHWAY 6 STE B
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City | FRESNO
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State | TX
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Zip | 77545-8844
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Country | US
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Telephone | 832-526-0194
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Fax |
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Provider Business Mailing Address
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Address Line | 6019 ACORN VALLEY LN
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City | RICHMOND
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State | TX
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Zip | 77469-6241
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Country | US
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Telephone | 832-526-0194
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | EDGAR LORET
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Credential |
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Telephone | 832-988-2753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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