Provider Demographics
NPI:1366108730
Name:POSITIVE LIFE CHANGES COUNSELING AND RECOVERY PLLC
Entity type:Organization
Organization Name:POSITIVE LIFE CHANGES COUNSELING AND RECOVERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:ALCALA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-489-5371
Mailing Address - Street 1:701 SANTA ISABEL BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2647
Mailing Address - Country:US
Mailing Address - Phone:361-489-5371
Mailing Address - Fax:
Practice Address - Street 1:701 SANTA ISABEL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAGUNA VISTA
Practice Address - State:TX
Practice Address - Zip Code:78578-2647
Practice Address - Country:US
Practice Address - Phone:361-489-5371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty