Provider Demographics
NPI:1700191822
Name:ADD/ADHD TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:ADD/ADHD TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-943-0410
Mailing Address - Street 1:PO BOX 940445
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-0445
Mailing Address - Country:US
Mailing Address - Phone:972-943-0410
Mailing Address - Fax:972-212-4270
Practice Address - Street 1:1524 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE A-1
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6406
Practice Address - Country:US
Practice Address - Phone:972-943-0410
Practice Address - Fax:972-212-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC5934207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1982607909OtherINDIVIDUAL NPI
TX1982607909OtherINDIVIDUAL NPI