Provider Demographics
NPI:1831551183
Name:HILL COUNTRY ART THERAPY COUNSELING
Entity type:Organization
Organization Name:HILL COUNTRY ART THERAPY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DETTMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-773-1687
Mailing Address - Street 1:15401 RANCH ROAD 12 STE 107
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-6245
Mailing Address - Country:US
Mailing Address - Phone:512-842-7550
Mailing Address - Fax:
Practice Address - Street 1:15401 RANCH ROAD 12 STE 107
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6245
Practice Address - Country:US
Practice Address - Phone:512-842-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73586251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX73586OtherLICENSE