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General NPI Number Information
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NPI Number | 1548521792
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Entity Type | Organization
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Legal Business Name | TEXAS YOUTH ADDICTION COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 16903 RED OAK DR STE 210
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City | HOUSTON
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State | TX
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Zip | 77090-3916
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Country | US
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Telephone | 832-208-6966
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Fax | 480-984-8898
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Provider Business Mailing Address
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Address Line | 505 WELLS FARGO DR APT 913
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City | HOUSTON
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State | TX
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Zip | 77090-4019
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Country | US
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Telephone | 832-208-6966
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Fax | 480-984-8898
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AARON HALLSTROM
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Credential | MS, LCDC
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Telephone | 832-208-6966
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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 | 11698
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License Number State | TX
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