Healthcare Provider Details

I. General information

NPI: 1477165660
Provider Name (Legal Business Name): ADDICTION CAMPUSES PROFESSIONAL SERVICES OF TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 SHADY LN
SCURRY TX
75158-2831
US

IV. Provider business mailing address

205 REIDHURST AVE
NASHVILLE TN
37203-1618
US

V. Phone/Fax

Practice location:
  • Phone: 972-452-2210
  • Fax: 469-721-6767
Mailing address:
  • Phone: 615-921-4447
  • Fax: 615-921-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LEIGH ANN THOMPSON
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 615-921-4447