MEDICARE: SPRING GROVE COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	101Y00000X	Counselor	62912	TX

General Provider Information

NPI Number	:	1134530561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING GROVE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	8104 SPRING CYPRESS RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3123
Country	:	US
Telephone Number	:	281-205-8786
Fax Number	:

Provider Business Practice Location Address
First Line	:	8104 SPRING CYPRESS RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3123
Country	:	US
Telephone Number	:	281-205-8786
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HEIDI GROVER
Credential	:	LPC
Telephone Number	:	281-919-3075

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	05/28/2024

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