Healthcare Provider Details

I. General information

NPI: 1972654820
Provider Name (Legal Business Name): HIGHLAND LAKES BEHAVIORAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 WEST HIGHWAY 190 SUITE B
COPPERAS COVE TX
76522
US

IV. Provider business mailing address

1001 AVENUE E
MARBLE FALLS TX
78654-5227
US

V. Phone/Fax

Practice location:
  • Phone: 254-542-7200
  • Fax: 866-602-0977
Mailing address:
  • Phone: 830-265-4554
  • Fax: 866-602-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11624
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number31593
License Number StateTX

VIII. Authorized Official

Name: DR. GREG HUPP
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 830-265-4554