Organization
TX OTP, LLC
Active
Other names
MAT Texas
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB GUERRERO (EXECUTIVE DIRECTOR)
(505) 730-6266
Entity
Organization
Contact information
Practice address
2100 N HWY 360 STE 1904, GRAND PRAIRIE, TX 75050-1040
(469) 460-7090
(469) 460-7091
Mailing address
2100 N HWY 360 STE 1904, GRAND PRAIRIE, TX 75050-1040
(505) 730-6266
(469) 460-7091
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
02/22/2022
Last updated
11/11/2024
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