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General NPI Number Information
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NPI Number | 1457417289
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Entity Type | Organization
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Legal Business Name | ADDICTION TREATMENT RESOURCES, LLC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4702 WESLEY ST STE D
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City | GREENVILLE
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State | TX
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Zip | 75401-5663
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Country | US
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Telephone | 903-455-4114
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Fax | 903-455-2814
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Provider Business Mailing Address
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Address Line | 4702 WESLEY ST STE D
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City | GREENVILLE
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State | TX
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Zip | 75401-5663
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Country | US
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Telephone | 903-455-4114
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Fax | 903-455-2814
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Authorized Official
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Title or Position | CEO
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Name | JAMES MINTO
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Credential | LCSW
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Telephone | 903-455-4114
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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 | 2465-A
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License Number State | TX
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