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General NPI Number Information
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NPI Number | 1811242217
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Entity Type | Organization
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Legal Business Name | FRESH START COUNSELING AND TREATMENT CENTER
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 215 EXECUTIVE WAY STE 140B
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City | DESOTO
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State | TX
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Zip | 75115-2396
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Country | US
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Telephone | 972-298-1146
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Fax | 972-298-1170
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Provider Business Mailing Address
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Address Line | 215 EXECUTIVE WAY STE 140B
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City | DESOTO
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State | TX
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Zip | 75115-2396
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Country | US
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Telephone | 972-298-1146
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Fax | 972-298-1170
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Authorized Official
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Title or Position | SPONSOR
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Name | MRS. GLADYS LOWRY
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Credential |
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Telephone | 972-365-9534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 1000032
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License Number State | TX
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