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1801419080
JONATHAN LANE RUST
MANOR, TX
NPI
1801419080
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: TX 15033)
Enumeration Date
2020-05-22
Last Update Date
2020-05-22
Business Address
JONATHAN LANE RUST LCDC
11503 PARSONS RD
MANOR, TX 78653-5220
Phone number: 512-278-4550
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Mailing Address
JONATHAN LANE RUST LCDC
11503 PARSONS RD
MANOR, TX 78653-5220
Phone number:
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