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General NPI Number Information
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NPI Number | 1104759158
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Entity Type | Organization
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Legal Business Name | ASIC RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 11105 N CENTRAL EXPY # 2230
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City | ALLEN
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State | TX
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Zip | 75013
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Country | US
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Telephone | 310-699-4229
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Fax |
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Provider Business Mailing Address
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Address Line | 455 MARKET ST STE 1940 PMB 212566
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-2448
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Country | US
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Telephone | 310-699-4229
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | THEA PHAM
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Credential |
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Telephone | 310-699-4229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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