MEDICARE: DUTCH-WILL ASSESSMENT GROUP LLC

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

General Provider Information

NPI Number	:	1477434017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUTCH-WILL ASSESSMENT GROUP LLC

Provider Business Mailing Address
First Line	:	7547 SUMMERDALE DR
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77469-4629
Country	:	US
Telephone Number	:	409-658-8384
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 CARTWRIGHT RD STE 303
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5309
Country	:	US
Telephone Number	:	409-658-8384
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BRENDA RILEY
Credential	:	LCDC
Telephone Number	:	409-658-8384

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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