1730373606 NPI number — COUNSELING CONNECTIONS FOR CHANGE INC

Table of content: (NPI 1730373606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730373606 NPI number — COUNSELING CONNECTIONS FOR CHANGE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING CONNECTIONS FOR CHANGE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730373606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 841656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-0020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-485-9280
Provider Business Mailing Address Fax Number:
281-485-9070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2549 ROY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77581-8604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-485-9280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAWLESS
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
832-277-0384

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW16888 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LMFT200891 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW32411 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LSOTP98965 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)