Provider Demographics
NPI:1760620728
Name:I CHOOSE CHANGE PLLC
Entity Type:Organization
Organization Name:I CHOOSE CHANGE PLLC
Other - Org Name:I CHOOSE CHANGE PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:214-547-1318
Mailing Address - Street 1:1506 N GREENVILLE AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8692
Mailing Address - Country:US
Mailing Address - Phone:214-547-1318
Mailing Address - Fax:214-550-2679
Practice Address - Street 1:1506 N GREENVILLE AVE STE 250
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8692
Practice Address - Country:US
Practice Address - Phone:214-547-1318
Practice Address - Fax:214-550-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19003101YM0800X
TX62011101YM0800X
TX62930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty