Provider Demographics
NPI:1649656695
Name:TEXAS FOUNDATION FOR SEXUAL SOBRIETY
Entity type:Organization
Organization Name:TEXAS FOUNDATION FOR SEXUAL SOBRIETY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-818-3450
Mailing Address - Street 1:901 COUNTY ROAD 281
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-8461
Mailing Address - Country:US
Mailing Address - Phone:512-778-5293
Mailing Address - Fax:
Practice Address - Street 1:901 COUNTY ROAD 281
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-8461
Practice Address - Country:US
Practice Address - Phone:512-778-5293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder