Provider Demographics
NPI:1396951034
Name:MID-TEXAS COUNCIL ON ALCOHOL AND DRUG ABUSE
Entity type:Organization
Organization Name:MID-TEXAS COUNCIL ON ALCOHOL AND DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASST.
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-646-8747
Mailing Address - Street 1:901 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-3313
Mailing Address - Country:US
Mailing Address - Phone:325-646-8747
Mailing Address - Fax:325-643-3512
Practice Address - Street 1:901 AVENUE B
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-3313
Practice Address - Country:US
Practice Address - Phone:325-646-8747
Practice Address - Fax:325-643-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1641A324500000X
TX1641261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility