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General NPI Number Information
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NPI Number | 1104798388
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Entity Type | Organization
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Legal Business Name | DEEP WATERS THERAPY, PLLC
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 11472 CLOVER KNOLL DR
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City | FRISCO
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State | TX
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Zip | 75035-8607
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Country | US
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Telephone | 904-390-1077
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Fax |
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Provider Business Mailing Address
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Address Line | 11472 CLOVER KNOLL DR
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City | FRISCO
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State | TX
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Zip | 75035-8607
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Country | US
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Telephone | 904-390-1077
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLIE HENRY
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Credential | LPC
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Telephone | 940-390-1077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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