Provider Demographics
NPI:1154696755
Name:DETTMER, NATALIE (LPC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:DETTMER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4379
Mailing Address - Country:US
Mailing Address - Phone:512-842-7550
Mailing Address - Fax:
Practice Address - Street 1:705 W HOPKINS ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4379
Practice Address - Country:US
Practice Address - Phone:512-842-7550
Practice Address - Fax:512-842-7550
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional