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General NPI Number Information
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NPI Number | 1790158384
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Entity Type | Organization
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Legal Business Name | MILESTONE TREATMENT CENTERS, LLC
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 412 N MAIN ST 209
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City | EULESS
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State | TX
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Zip | 76039-3652
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Country | US
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Telephone | 817-919-6674
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Fax |
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Provider Business Mailing Address
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Address Line | 412 N MAIN ST 209
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City | EULESS
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State | TX
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Zip | 76039-3652
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Country | US
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Telephone | 817-919-6674
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. RON STEIN
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Credential | LPC
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Telephone | 817-919-6674
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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 | 71047
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License Number State | TX
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