Provider Demographics
NPI:1669928800
Name:ALLIANCE FOR BEHAVIORAL CHANGE CENTER
Entity type:Organization
Organization Name:ALLIANCE FOR BEHAVIORAL CHANGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-920-0431
Mailing Address - Street 1:6718 HAVEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3428
Mailing Address - Country:US
Mailing Address - Phone:210-920-0431
Mailing Address - Fax:210-579-8420
Practice Address - Street 1:6718 HAVEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3428
Practice Address - Country:US
Practice Address - Phone:210-920-0431
Practice Address - Fax:210-579-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty