Provider Demographics
NPI:1669806634
Name:SET FREE D.A.T. CENTER, INC.
Entity type:Organization
Organization Name:SET FREE D.A.T. CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGY/PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCDC
Authorized Official - Phone:832-578-2924
Mailing Address - Street 1:3333 FANNIN ST
Mailing Address - Street 2:SUITE NUMBER 111
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-2950
Mailing Address - Country:US
Mailing Address - Phone:713-520-8042
Mailing Address - Fax:713-942-7866
Practice Address - Street 1:3333 FANNIN ST
Practice Address - Street 2:SUITE NUMBER 111
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2950
Practice Address - Country:US
Practice Address - Phone:713-520-8042
Practice Address - Fax:713-942-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1778 - 1778 A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder