Healthcare Provider Details

I. General information

NPI: 1508126020
Provider Name (Legal Business Name): STONE SPRINGS WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 VICTORINE LN APT A
DEL VALLE TX
78617-3032
US

IV. Provider business mailing address

3520 VICTORINE LN APT A
DEL VALLE TX
78617-3032
US

V. Phone/Fax

Practice location:
  • Phone: 512-520-7840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT111365
License Number StateTX

VIII. Authorized Official

Name: JASON DANNER MINNIX
Title or Position: DIRECTOR
Credential:
Phone: 512-520-7840