MEDICARE: GGC CLINIC PLLC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1356876148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GGC CLINIC PLLC

Provider Business Mailing Address
First Line	:	6420 HILLCROFT ST STE 411
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-3103
Country	:	US
Telephone Number	:	832-791-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 HILLCROFT ST STE 411
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-3103
Country	:	US
Telephone Number	:	832-791-3520
Fax Number	:

Authorized Official
Title or Position	:	AGENT
Name	:	WILMA MARTINEZ
Credential	:
Telephone Number	:	832-791-3520

Provider Enumeration Date	:	04/29/2017
Last Update Date	:	04/29/2017

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