MEDICARE: WINDS OF CHANGE RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1659145423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDS OF CHANGE RECOVERY LLC

Provider Business Mailing Address
First Line	:	2323 S VOSS RD STE 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 S VOSS RD STE 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3832
Country	:	US
Telephone Number	:	713-205-6298
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, CHIEF OF OPERATIONS (COO)
Name	:	JACOB DANIELS
Credential	:
Telephone Number	:	713-469-0502

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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Directions to “WINDS OF CHANGE RECOVERY LLC ” Practice Location

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