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General NPI Number Information
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NPI Number | 1225356363
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Entity Type | Organization
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Legal Business Name | SBX TX OTB, PLLC
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 106 BELINDA BLVD
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City | DANVILLE
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State | KY
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Zip | 40422
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Country | US
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Telephone | 859-209-2320
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Fax | 859-209-4278
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Provider Business Mailing Address
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Address Line | PO BOX 1050
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City | DANVILLE
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State | KY
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Zip | 40423
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Country | US
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Telephone | 859-209-2295
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Fax | 859-236-5152
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES HASTINGS DURHAM
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Credential |
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Telephone | 859-209-2305
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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 |
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