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Organization

CHANGE AGENTS OF SOCIAL SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JADEN HINES (CHIEF EXECUTIVE OFFICER)
(702) 305-0652
Entity
Organization

Contact information

Practice address
840 CANTON GRASS LN, LA MARQUE, TX 77568-1007
(702) 305-0652
Mailing address
840 CANTON GRASS LN, LA MARQUE, TX 77568-1007

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
103K00000X
Behavior Analyst
104100000X
Social Worker
171M00000X
Case Manager/Care Coordinator
251S00000X
Community/Behavioral Health Agency
Primary
252Y00000X
Early Intervention Provider Agency
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
373H00000X
Day Training/Habilitation Specialist

Other

Enumeration date
02/26/2024
Last updated
02/26/2024
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