Healthcare Provider Details

I. General information

NPI: 1982983706
Provider Name (Legal Business Name): SPIRIT REINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 COUNTY ROAD 284
LIBERTY HILL TX
78642-6077
US

IV. Provider business mailing address

PO BOX 368
LIBERTY HILL TX
78642-0368
US

V. Phone/Fax

Practice location:
  • Phone: 512-515-0845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE WEIXEL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 512-515-0845