=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396938452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFAIR RECOVERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4131 SPICEWOOD SPRINGS RD BLDG. K1
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-8661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-346-9299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4131 SPICEWOOD SPRINGS RD BLDG. K1
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-8661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-346-9299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RICHARD LYNN REYNOLDS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 512-346-9299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 18290
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------