Organization
PROFESSIONAL HOME DETOX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. COURTNEY CAROLE FULLER BSN, RN (PROGRAM DIRECTOR)
(806) 773-6575
Entity
Organization
Contact information
Practice address
8104 COUNTY ROAD 6500, LUBBOCK, TX 79416-9557
(806) 773-6575
Mailing address
8104 COUNTY ROAD 6500, LUBBOCK, TX 79416-9557
(806) 773-6575
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
671297
TX
Other
Enumeration date
07/25/2011
Last updated
07/25/2011
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