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General NPI Number Information
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NPI Number | 1396458477
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Entity Type | Organization
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Legal Business Name | GALLUS DETOX HOUSTON PLLC
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 2490 FM 2920 RD # 102
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City | SPRING
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State | TX
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Zip | 77388-3417
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Country | US
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Telephone | 844-548-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 225 E 16TH AVE STE 1100
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City | DENVER
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State | CO
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Zip | 80203-1615
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Country | US
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Telephone | 720-501-2225
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | MS. GEORGINA CARROLL
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Credential |
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Telephone | 928-533-0872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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