Provider Demographics
NPI:1104122738
Name:ANOTHER CHANCE 4 CHANGE
Entity type:Organization
Organization Name:ANOTHER CHANCE 4 CHANGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AUBURNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:512-731-5243
Mailing Address - Street 1:2851 JOE DIMAGGIO BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3927
Mailing Address - Country:US
Mailing Address - Phone:512-731-5243
Mailing Address - Fax:512-238-1961
Practice Address - Street 1:2851 JOE DIMAGGIO BLVD
Practice Address - Street 2:STE 4
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3927
Practice Address - Country:US
Practice Address - Phone:512-731-5243
Practice Address - Fax:512-238-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-29
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10616101YA0400X
TX33763377324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty