Provider Demographics
NPI:1659709475
Name:RECOVERY RESOURCE COUNCIL
Entity Type:Organization
Organization Name:RECOVERY RESOURCE COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDERMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-332-6329
Mailing Address - Street 1:2700 AIRPORT FWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-2332
Mailing Address - Country:US
Mailing Address - Phone:817-332-6329
Mailing Address - Fax:817-332-2828
Practice Address - Street 1:2700 AIRPORT FWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-2332
Practice Address - Country:US
Practice Address - Phone:817-332-6329
Practice Address - Fax:817-332-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3399-3400101YA0400X
101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308711601Medicaid