MEDICARE: WEST TEXAS COUNSELING AND REHABILITATION OF DALLAS, INC.

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	261QM2800X	Methadone Clinic
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	0000050	TX

General Provider Information

NPI Number	:	1881725752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST TEXAS COUNSELING AND REHABILITATION OF DALLAS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 303249
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-0055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 MARKET CENTER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-3315
Country	:	US
Telephone Number	:	214-630-7146
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IVAN GARCIA
Credential	:	MD
Telephone Number	:	214-630-7146

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	04/29/2021

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