Provider Demographics
NPI:1457796336
Name:HOUSTON SUBSTANCE ABUSE CLINIC, INC.
Entity type:Organization
Organization Name:HOUSTON SUBSTANCE ABUSE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-351-5341
Mailing Address - Street 1:7428 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4442
Mailing Address - Country:US
Mailing Address - Phone:713-643-5858
Mailing Address - Fax:713-643-2967
Practice Address - Street 1:7428 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4442
Practice Address - Country:US
Practice Address - Phone:713-643-5858
Practice Address - Fax:713-643-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX-10113-M324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility