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General NPI Number Information
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NPI Number | 1962163709
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE AND RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 5625 GOOD SHEPHERD WAY
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City | FORT WORTH
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State | TX
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Zip | 76119-4233
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Country | US
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Telephone | 817-480-7599
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 PARKVIEW TRL
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City | KENNEDALE
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State | TX
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Zip | 76060-5841
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Country | US
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Telephone | 817-584-9368
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | JASON KING
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Credential | LCDC
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Telephone | 817-584-9368
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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 |
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License Number State |
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