Provider Demographics
NPI:1609466069
Name:SUBSTANCE ABUSE GUIDANCE AND EDUCATION, LLC
Entity Type:Organization
Organization Name:SUBSTANCE ABUSE GUIDANCE AND EDUCATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXE. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORREAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:512-698-4951
Mailing Address - Street 1:165 CHURCHILL CIR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-2821
Mailing Address - Country:US
Mailing Address - Phone:817-238-9911
Mailing Address - Fax:817-237-5711
Practice Address - Street 1:3980 BOAT CLUB RD STE 207
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3207
Practice Address - Country:US
Practice Address - Phone:817-238-9911
Practice Address - Fax:817-237-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty