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General NPI Number Information
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NPI Number | 1003266776
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Entity Type | Organization
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Legal Business Name | HILLARY MARVIN
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 6602 IVYWOOD DR
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City | SAN ANTONIO
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State | TX
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Zip | 78249-4856
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Country | US
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Telephone | 281-467-4917
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Fax |
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Provider Business Mailing Address
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Address Line | 6602 IVYWOOD DR
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City | SAN ANTONIO
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State | TX
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Zip | 78249-4856
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Country | US
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Telephone | 281-467-4917
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | HILLARY MARVIN
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Credential | LPC
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Telephone | 281-467-4917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 71859
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License Number State | TX
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