Healthcare Provider Details

I. General information

NPI: 1982062816
Provider Name (Legal Business Name): HILL COUNTRY OCD TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2016
Last Update Date: 02/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 JOE DIMAGGIO BLVD SUITE 66
ROUND ROCK TX
78665-3922
US

IV. Provider business mailing address

3355 BEE CAVES RD SUITE 508
WEST LAKE HILLS TX
78746-6775
US

V. Phone/Fax

Practice location:
  • Phone: 512-636-0104
  • Fax:
Mailing address:
  • Phone: 512-636-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number36270
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number54539
License Number StateTX

VIII. Authorized Official

Name: SAMANTHA L BRAY
Title or Position: CO-OWNER
Credential: LCSW
Phone: 512-636-0104