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General NPI Number Information
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NPI Number | 1003121526
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Entity Type | Organization
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Legal Business Name | HUNTSVILLE CLINIC, INC.
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 501 EVERETT ST
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City | CONROE
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State | TX
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Zip | 77301-1826
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Country | US
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Telephone | 936-441-9172
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Fax | 936-441-9177
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Provider Business Mailing Address
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Address Line | 501 EVERETT ST
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City | CONROE
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State | TX
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Zip | 77301-1826
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Country | US
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Telephone | 936-441-9172
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Fax | 936-441-9177
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Authorized Official
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Title or Position | CEO
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Name | MS. STACEY R HARRIS
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Credential | LCDC
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Telephone | 936-441-9172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | TX-10235-M
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License Number State | TX
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