Provider Demographics
NPI:1336254184
Name:STAR COUNCIL ON SUBSTANCE ABUSE
Entity Type:Organization
Organization Name:STAR COUNCIL ON SUBSTANCE ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOITNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-965-5515
Mailing Address - Street 1:239 S VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-4344
Mailing Address - Country:US
Mailing Address - Phone:254-965-5515
Mailing Address - Fax:254-965-7416
Practice Address - Street 1:239 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-4344
Practice Address - Country:US
Practice Address - Phone:254-965-5515
Practice Address - Fax:254-965-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX859-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder