Provider Demographics
NPI:1194186460
Name:BEHAVIORAL MEDICINE AND ADDICTIVE DISORDERS, HOUSTON
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE AND ADDICTIVE DISORDERS, HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:318-884-4205
Mailing Address - Street 1:195 COLONEL AP KOUNS DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2977
Mailing Address - Country:US
Mailing Address - Phone:318-884-4205
Mailing Address - Fax:
Practice Address - Street 1:195 COLONEL AP KOUNS DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2977
Practice Address - Country:US
Practice Address - Phone:318-884-4205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health