Provider Demographics
NPI:1548521792
Name:TEXAS YOUTH ADDICTION COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:TEXAS YOUTH ADDICTION COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCDC
Authorized Official - Phone:832-208-6966
Mailing Address - Street 1:505 WELLS FARGO DR APT 913
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-4019
Mailing Address - Country:US
Mailing Address - Phone:832-208-6966
Mailing Address - Fax:480-984-8898
Practice Address - Street 1:16903 RED OAK DR STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3916
Practice Address - Country:US
Practice Address - Phone:832-208-6966
Practice Address - Fax:480-984-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11698101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty