STAGES OF RECOVERY - WACO STAGES OF RECOVERY - WACO 24-03026-10250

700 N ROBINSON DR. 4413 71ST STREET, STE G-101 0133

ROBINSON, TX 767065050 LUBBOCK, TX 794242319
261240810 041524 041824
W260182339 407 GIBRALTAR LN
TIGELAAR, MARY LORENA TX 76655

01281975 F 031824 14 3 9 30

AETNA
PO BOX 981106
EL PASO, TX 79998

0906 INTENSIVE OUTPATIENT, SUBSTANCE USE DISORDERS H0015 041524 1 1,250.00

0906 INTENSIVE OUTPATIENT, SUBSTANCE USE DISORDERS H0015 041624 1 1,250.00
0906 INTENSIVE OUTPATIENT, SUBSTANCE USE DISORDERS H0015 041724 1 1,250.00
0906 INTENSIVE OUTPATIENT, SUBSTANCE USE DISORDERS H0015 041824 1 1,250.00

1 1 050624 5,000.00
1558803270
AETNA 60054 Y Y

TIGELAAR, BRIAN 01 W260182339 14197401000006

NO AUTH REQUIRED

F1020 Y

F1020
1740988286
JENSON NAUGHTON AYLA