Healthcare Provider Details

I. General information

NPI: 1669802997
Provider Name (Legal Business Name): HILL COUNTRY MHDD CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WATER ST SUITE 300
KERRVILLE TX
78028-5333
US

IV. Provider business mailing address

819 WATER ST SUITE 300
KERRVILLE TX
78028-5333
US

V. Phone/Fax

Practice location:
  • Phone: 830-792-3300
  • Fax: 830-792-5771
Mailing address:
  • Phone: 830-792-3300
  • Fax: 830-792-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number62054
License Number StateTX

VIII. Authorized Official

Name: LISA M SNEAD
Title or Position: CREDENTIALING OFFICER
Credential: LPC
Phone: 830-792-3300