Provider Demographics
NPI:1639805690
Name:ADDICTION BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:ADDICTION BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CASHEN-LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, LCDC
Authorized Official - Phone:817-905-9704
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:RHOME
Mailing Address - State:TX
Mailing Address - Zip Code:76078-0404
Mailing Address - Country:US
Mailing Address - Phone:817-905-9704
Mailing Address - Fax:
Practice Address - Street 1:3936 S HIGHWAY 287 STE 1
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-5076
Practice Address - Country:US
Practice Address - Phone:817-905-9704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1639805690OtherMEDICAID