=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124570114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADDICTION TREATMENT RESOURCES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2016
-----------------------------------------------------
Last Update Date | 12/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 W. PARKER RD STE. 530A
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-856-9926
-----------------------------------------------------
Fax | 888-242-9976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1505 HARROUN AVE F
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-3432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-856-9926
-----------------------------------------------------
Fax | 888-242-9976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING CLERK
-----------------------------------------------------
Name | MRS. BARBARA SHELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-422-0429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 6388
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------