Healthcare Provider Details

I. General information

NPI: 1508683186
Provider Name (Legal Business Name): DENISE KOTSONIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 RANCH ROAD 620 S
LAKEWAY TX
78734-6311
US

IV. Provider business mailing address

5501 S MOPAC EXPY APT 1223
AUSTIN TX
78749-1180
US

V. Phone/Fax

Practice location:
  • Phone: 510-263-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number90222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: