Organization
KSA ADDICTION TREATMENT LLC
Active
Other names
LCDC
Organization subpart
No
Provider details
NPI number
Authorized official
MYLAN WATSON-SHAW LCDC (LICENSED CHEMICAL DEPENDENCY)
(469) 321-1346
Entity
Organization
Contact information
Practice address
132 HILLSIDE LN, DESOTO, TX 75115-5910
(469) 321-1346
Mailing address
132 HILLSIDE LN, DESOTO, TX 75115-5910
(469) 321-1346
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/02/2021
Last updated
11/10/2021
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