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General NPI Number Information
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NPI Number | 1194974642
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Entity Type | Organization
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Legal Business Name | JAMAICAN MOON GROUP, LLC
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 1050 N WESTMORELAND RD
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City | DALLAS
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State | TX
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Zip | 75211-2444
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Country | US
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Telephone | 214-330-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 930 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75067-3644
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Country | US
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Telephone | 214-222-2100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOB SCOUTEN
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Credential |
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Telephone | 214-222-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | TX
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