Provider Demographics
NPI:1912340209
Name:SPILLAR, DEREK JEFFREY (LPC, LSOTP)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JEFFREY
Last Name:SPILLAR
Suffix:
Gender:M
Credentials:LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 COUNTY ROAD 405
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:78947-4941
Mailing Address - Country:US
Mailing Address - Phone:512-923-2987
Mailing Address - Fax:
Practice Address - Street 1:2391 COUNTY ROAD 405
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TX
Practice Address - Zip Code:78947-4941
Practice Address - Country:US
Practice Address - Phone:512-923-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional