Professional Home Detox

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

671297 Issued in TX

Legal business name

PROFESSIONAL HOME DETOX

Practice address

8104 County Road 6500
Lubbock, TX 79416-9557

Phone

(806) 773-6575

NPI assigned

Jul 25, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Courtney Carole Fuller, BSN, RNNPI 1437437464

Title

Program Director

Phone

(806) 773-6575

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Courtney Carole Fuller, BSN, RN

  • Addiction (Substance Use Disorder) Registered Nurse
  • Lubbock, TX
  • NPI 1437437464
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311552000000",
    "number": "1407134448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8104 COUNTY ROAD 6500",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794169557",
            "telephone_number": "806-773-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8104 COUNTY ROAD 6500",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794169557",
            "telephone_number": "806-773-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL HOME DETOX",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-25",
        "last_updated": "2011-07-25",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "CAROLE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "806-773-6575",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSN, RN"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "TX",
            "license": "671297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Matthew Pringle, PA-C
• Patrick Pritchett, RPH
• Karla Privett, LCSW
• Monja L Proctor, MD
• Professional Eyewear
• Professional Opticians, L.L.C.
• Jennifer Anne Proffitt, PA-C
• Progressive Counseling Services
• Cristi Props, OT
• Erick Props, MPT

• Substance Use Disorder Rehabilitation Clinic/Center in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.