Provider Demographics
NPI:1033694914
Name:SAVAGE, JIM (LCDC)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 KELLER SPRINGS RD STE 180
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6263
Mailing Address - Country:US
Mailing Address - Phone:214-789-8456
Mailing Address - Fax:
Practice Address - Street 1:4950 KELLER SPRINGS RD STE 180
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6263
Practice Address - Country:US
Practice Address - Phone:214-789-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3353101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)