Provider Demographics
NPI:1417550567
Name:2D CHANGE INC.
Entity Type:Organization
Organization Name:2D CHANGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROOSEVELT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-588-3425
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191
Mailing Address - Country:US
Mailing Address - Phone:702-588-3425
Mailing Address - Fax:702-208-2090
Practice Address - Street 1:2725 S. JONES BLVD. SUITE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-829-6429
Practice Address - Fax:702-208-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20071459752OtherSTATE BUSINESS LICENSE NUMBER