Provider Demographics
NPI:1164871323
Name:ADVANCED MIND AND RECOVERY LLC
Entity Type:Organization
Organization Name:ADVANCED MIND AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-337-2400
Mailing Address - Street 1:1776 YORKTOWN ST
Mailing Address - Street 2:STE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4182
Mailing Address - Country:US
Mailing Address - Phone:713-337-2400
Mailing Address - Fax:713-987-7735
Practice Address - Street 1:1776 YORKTOWN ST
Practice Address - Street 2:STE 550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4182
Practice Address - Country:US
Practice Address - Phone:713-337-2400
Practice Address - Fax:713-987-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4044-4045261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder