# KSA ADDICTION TREATMENT LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** LCDC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750046074
- **Authorized official:** MYLAN WATSON-SHAW LCDC (LICENSED CHEMICAL DEPENDENCY)
- **Authorized official phone:** (469) 321-1346

## Contact information

- **Practice address:** 132 HILLSIDE LN, DESOTO, TX 75115-5910
- **Practice address phone:** (469) 321-1346
- **Mailing address:** 132 HILLSIDE LN, DESOTO, TX 75115-5910
- **Mailing address phone:** (469) 321-1346

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 11/02/2021
- **Last updated:** 11/10/2021