MEDICARE: ALCOHOL & OTHER DRUGS RESOURCE, 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	3588	TX

General Provider Information

NPI Number	:	1407193360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALCOHOL & OTHER DRUGS RESOURCE, PLLC

Provider Business Mailing Address
First Line	:	17629 EL CAMINO REAL
Second Line	:	STE. 115
City	:	HOUSTON
State	:	TX
Zip	:	77058-2901
Country	:	US
Telephone Number	:	281-971-1969
Fax Number	:	281-249-5009

Provider Business Practice Location Address
First Line	:	17629 EL CAMINO REAL
Second Line	:	STE. 115
City	:	HOUSTON
State	:	TX
Zip	:	77058-2901
Country	:	US
Telephone Number	:	281-971-1969
Fax Number	:	281-249-5009

Authorized Official
Title or Position	:	PARTNER
Name	:	TAMMY SAMOUR
Credential	:	MS, LPC, LCDC, SAP
Telephone Number	:	281-326-7946

Provider Enumeration Date	:	01/12/2013
Last Update Date	:	01/12/2013

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