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General NPI Number Information
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NPI Number | 1750657920
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Entity Type | Organization
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Legal Business Name | ADDICTION MEDICINE CONSULTANTS OF TEXAS, PLLC
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Dates
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Enumeration Date | 03/31/2012
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 37131 INTERSTATE 10 W SUITE 101
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City | BOERNE
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State | TX
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Zip | 78006-8989
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Country | US
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Telephone | 512-577-8666
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Fax | 830-255-4660
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Provider Business Mailing Address
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Address Line | 37131 INTERSTATE 10 W SUITE 101
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City | BOERNE
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State | TX
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Zip | 78006-8989
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Country | US
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Telephone | 512-577-8666
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEFFREY L BUTTS
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Credential | DO
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Telephone | 512-426-8343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 672526
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | H7939
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License Number State | TX
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