# CLEANSLATE MEDICAL GROUP OF TEXAS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487192522
- **Authorized official:** JESSICA AMICK (DIRECTOR)
- **Authorized official phone:** (727) 798-8160

## Contact information

- **Practice address:** 2912 KRAFT ST STE 30, ARLINGTON, TX 76010-5410
- **Practice address phone:** (413) 584-2173
- **Mailing address:** 8 CADILLAC DR STE 180, BRENTWOOD, TN 37027-5393
- **Mailing address phone:** (154) 250-0220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/09/2017
- **Last updated:** 03/23/2023