Provider Demographics
NPI:1225535644
Name:ROOM FOR CHANGE
Entity Type:Organization
Organization Name:ROOM FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESQUIVEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC- SUPERVISOR, LCD
Authorized Official - Phone:940-230-3381
Mailing Address - Street 1:3256 SOUTHERN DR STE 461
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1533
Mailing Address - Country:US
Mailing Address - Phone:940-230-3381
Mailing Address - Fax:
Practice Address - Street 1:3256 SOUTHERN DR STE 461
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1533
Practice Address - Country:US
Practice Address - Phone:940-230-3381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty