=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841408184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY AREA COUNCIL ON DRUGS & ALCOHOL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 07/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300A BAY AREA BLVD. STE 102
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-212-2900
-----------------------------------------------------
Fax | 281-212-2901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300A BAY AREA BLVD. STE 102
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-212-2900
-----------------------------------------------------
Fax | 281-212-2901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CORE SERVICES
-----------------------------------------------------
Name | DANIEL GARZA
-----------------------------------------------------
Credential | LCDC
-----------------------------------------------------
Telephone | 281-212-2900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 6467
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 3691
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 11988
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------