Basic Information
| Provider Information | |||||||||
| NPI: | 1306018130 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUANTUM CHANGE CONSULTANTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11702B GRANT RD | ||||||||
| Address2: | SUITE 422 | ||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774292983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139226751 | ||||||||
| FaxNumber: | 8663303497 | ||||||||
| Practice Location | |||||||||
| Address1: | 16300 KATY FWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770941609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139226751 | ||||||||
| FaxNumber: | 8663303497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2008 | ||||||||
| LastUpdateDate: | 04/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | MALONE | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7139226751 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 16987 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 16987 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | 16987 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.