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General NPI Number Information
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NPI Number | 1225351794
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Entity Type | Organization
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Legal Business Name | GEORGETOWN PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 518 E HOSPITAL STREET
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City | NACOGDOCHES
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State | TX
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Zip | 75961
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Country | US
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Telephone | 936-462-8577
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Fax | 936-228-9072
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Provider Business Mailing Address
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Address Line | 518 E HOSPITAL STREET
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City | NACOGDOCHES
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State | TX
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Zip | 75961
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Country | US
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Telephone | 936-462-8577
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Fax | 936-228-9072
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Authorized Official
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Title or Position | OWNER
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Name | DR. SYDNEY KROLL REGISTER
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Credential | PSYD
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Telephone | 936-462-8577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 34032
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License Number State | TX
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