MEDICARE: TR HEALTH GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		TX

General Provider Information

NPI Number	:	1225425705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TR HEALTH GROUP

Provider Business Mailing Address
First Line	:	6600 LBJ FWY
Second Line	:	SUITE 240
City	:	DALLAS
State	:	TX
Zip	:	75240-6514
Country	:	US
Telephone Number	:	626-427-2477
Fax Number	:	626-427-2477

Provider Business Practice Location Address
First Line	:	6600 LBJ FWY
Second Line	:	SUITE 240
City	:	DALLAS
State	:	TX
Zip	:	75240-6514
Country	:	US
Telephone Number	:	626-427-2477
Fax Number	:	626-427-2477

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. KEVIN GILLILAND
Credential	:	PSY. D
Telephone Number	:	626-427-2477

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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