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General NPI Number Information
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NPI Number | 1053699124
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Entity Type | Organization
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Legal Business Name | CHANGE INSTITUTE CENTER
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Dates
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Enumeration Date | 07/23/2011
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Last Update Date | 07/23/2011
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Provider Practice Location Address
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Address Line | 8888 W BELLFORT ST
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City | HOUSTON
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State | TX
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Zip | 77031-2406
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Country | US
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Telephone | 832-741-9457
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Fax | 713-988-2820
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Provider Business Mailing Address
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Address Line | PO BOX 710253
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City | HOUSTON
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State | TX
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Zip | 77271-0253
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Country | US
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Telephone | 832-741-9457
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Fax | 713-988-2820
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LORETTA LOVON HENDERSON
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Credential | MA, MS
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Telephone | 832-741-9457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | TX
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Taxonomy #4
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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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