Provider Demographics
NPI:1487869632
Name:AUSTIN DRUG AND ALCOHOL ABUSE PROGRAM INC
Entity type:Organization
Organization Name:AUSTIN DRUG AND ALCOHOL ABUSE PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC, SAP
Authorized Official - Phone:512-454-8180
Mailing Address - Street 1:7801 N LAMAR BLVD
Mailing Address - Street 2:SUITE D-109
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1016
Mailing Address - Country:US
Mailing Address - Phone:512-454-8180
Mailing Address - Fax:512-454-7441
Practice Address - Street 1:7801 N LAMAR BLVD
Practice Address - Street 2:SUITE D-109
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1016
Practice Address - Country:US
Practice Address - Phone:512-454-8180
Practice Address - Fax:512-454-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654A101YA0400X
TX654-3266324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J52AOtherBLUE CROSS BLUE SHEILD