Healthcare Provider Details

I. General information

NPI: 1396915476
Provider Name (Legal Business Name): MARY S HOEKSTRA LPA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 GLASCOW ST
VICTORIA TX
77904-1406
US

IV. Provider business mailing address

506 GLASCOW ST
VICTORIA TX
77904-1406
US

V. Phone/Fax

Practice location:
  • Phone: 361-576-3385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number33822
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: