Ksa Addiction Treatment LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

KSA ADDICTION TREATMENT LLC

Practice address

132 Hillside LN
Desoto, TX 75115-5910

Phone

(469) 321-1346

NPI assigned

Nov 2, 2021

Organization subpart

No

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

Authorized official

Name

Mylan Watson-Shaw, LCDC

Title

Licensed Chemical Dependency

Phone

(469) 321-1346

Specialties & licenses 1

Addresses

Other names 1

• LCDC Doing business as

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1750046074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 HILLSIDE LN",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751155910",
            "telephone_number": "469-321-1346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 HILLSIDE LN",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751155910",
            "telephone_number": "469-321-1346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSA ADDICTION TREATMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "WATSON-SHAW",
        "authorized_official_first_name": "MYLAN",
        "authorized_official_title_or_position": "LICENSED  CHEMICAL DEPENDENCY",
        "authorized_official_telephone_number": "469-321-1346",
        "authorized_official_credential": "LCDC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LCDC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LCDC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dunia Korous, DDS
• Srinath Kotamarti
• Praveen G Kottackal- Varkey, DDS
• Mahesh B Kottapalli, MD
• Kroger Texas L P
• Simone Kurney, PHLEBOTOMIST LICENSE
• Kusi Fordjour M.D PA
• Haley H Kutch, DPT
• Ladair Integrated Health PLLC
• Shemika Lafitte, HAIR LOSS SPECIALIST

• Addiction (Substance Use Disorder) Counselor in Desoto, TX
• Providers in Desoto, TX by specialty
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; 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.