Provider Demographics
NPI:1750118998
Name:SFC CHANGE PLLC
Entity type:Organization
Organization Name:SFC CHANGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:PERALES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-706-4786
Mailing Address - Street 1:1608 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3128
Mailing Address - Country:US
Mailing Address - Phone:702-706-4786
Mailing Address - Fax:
Practice Address - Street 1:209 PEDERNALES ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4744
Practice Address - Country:US
Practice Address - Phone:702-706-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty