Healthcare Provider Details

I. General information

NPI: 1750657920
Provider Name (Legal Business Name): ADDICTION MEDICINE CONSULTANTS OF TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2012
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37131 INTERSTATE 10 W SUITE 101
BOERNE TX
78006-8989
US

IV. Provider business mailing address

37131 INTERSTATE 10 W SUITE 101
BOERNE TX
78006-8989
US

V. Phone/Fax

Practice location:
  • Phone: 512-577-8666
  • Fax: 830-255-4660
Mailing address:
  • Phone: 512-577-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberH7939
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number672526
License Number StateTX

VIII. Authorized Official

Name: DR. JEFFREY L BUTTS
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 512-426-8343