The Initiative for Change and Development

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

11387 Issued in TX

Legal business name

THE INITIATIVE FOR CHANGE AND DEVELOPMENT

Practice address

1146 Willow Creek Dr
La Porte, TX 77571-2711

Phone

(832) 964-3849

NPI assigned

Aug 18, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alan Blackshear, LCDC, CART, COPSD

Title

Director

Phone

(832) 964-3849

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408320000000",
    "number": "1184023970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1146 WILLOW CREEK DRIVE",
            "city": "LA PORTE",
            "state": "TX",
            "postal_code": "77571",
            "telephone_number": "832-964-3849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1146 WILLOW CREEK DR",
            "city": "LA PORTE",
            "state": "TX",
            "postal_code": "775712711",
            "telephone_number": "832-964-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE INITIATIVE FOR CHANGE AND DEVELOPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-18",
        "last_updated": "2014-08-18",
        "status": "A",
        "authorized_official_last_name": "BLACKSHEAR",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "832-964-3849",
        "authorized_official_credential": "LCDC, CART, COPSD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TX",
            "license": "11387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in La Porte, TX
• Providers in La Porte, TX by specialty
• Community/Behavioral Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.