# GALLUS DETOX DALLAS LLC

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

## Provider details

- **NPI number:** 1659616647
- **Authorized official:** PATRICK JOHN GALLUS M.D. (PRESIDENT)
- **Authorized official phone:** (928) 227-2300

## Contact information

- **Practice address:** 26791 US HIGHWAY 380 E, AUBREY, TX 76227-7654
- **Practice address phone:** (281) 277-0911
- **Mailing address:** 134 S GRANITE ST, PRESCOTT, AZ 86303-4710
- **Mailing address phone:** (928) 227-2300
- **Mailing address fax:** (928) 445-1416

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | — |
| 207PT0002X | Medical Toxicology (Emergency Medicine) Physician | — | NULL | Yes |
| 207PT0002X | Medical Toxicology (Emergency Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/03/2012
- **Last updated:** 12/11/2012