Provider Demographics
NPI:1023858727
Name:THE CHANGE LLC
Entity type:Organization
Organization Name:THE CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LORET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-988-2753
Mailing Address - Street 1:6019 ACORN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6241
Mailing Address - Country:US
Mailing Address - Phone:832-526-0194
Mailing Address - Fax:
Practice Address - Street 1:12125 HIGHWAY 6 STE B
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8844
Practice Address - Country:US
Practice Address - Phone:832-526-0194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)