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General NPI Number Information
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NPI Number | 1356103105
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Entity Type | Organization
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Legal Business Name | MY FRIEND JACK'S HOUSE
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 2000 N MCDONALD ST STE 400
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City | MCKINNEY
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State | TX
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Zip | 75071-3036
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Country | US
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Telephone | 214-585-1414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1146
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City | VAN ALSTYNE
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State | TX
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Zip | 75495-1146
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Country | US
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Telephone | 214-585-1414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BONNIE DONALDSON
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Credential | LCDC, CFLE
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Telephone | 214-585-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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