MEDICARE: ADD/ADHD TREATMENT CENTER 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	207Q00000X	Family Medicine Physician	C5934	TX
2	208000000X	Pediatrics Physician	C5934	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1982607909	OTHER	TX	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1700191822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADD/ADHD TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 940445
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75094-0445
Country	:	US
Telephone Number	:	972-943-0410
Fax Number	:	972-212-4270

Provider Business Practice Location Address
First Line	:	1524 INDEPENDENCE PKWY
Second Line	:	SUITE A-1
City	:	PLANO
State	:	TX
Zip	:	75075-6406
Country	:	US
Telephone Number	:	972-943-0410
Fax Number	:	972-212-4270

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ROBERT C YOUNG
Credential	:	MD
Telephone Number	:	972-943-0410

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	08/12/2010

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Directions to “ADD/ADHD TREATMENT CENTER LLC ” Practice Location

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