Provider Demographics
NPI:1912239583
Name:AVENUES TO CHANGE
Entity Type:Organization
Organization Name:AVENUES TO CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC, NCC
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:469-693-0305
Mailing Address - Street 1:915 LAKE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-8409
Mailing Address - Country:US
Mailing Address - Phone:469-693-0305
Mailing Address - Fax:972-292-7808
Practice Address - Street 1:915 LAKE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-8409
Practice Address - Country:US
Practice Address - Phone:469-693-0305
Practice Address - Fax:972-292-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62863101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty