=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336618354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GALYON COUNSELING SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2018
-----------------------------------------------------
Last Update Date | 03/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1811A N US HIGHWAY 281 STE 4
-----------------------------------------------------
City | MARBLE FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78654-4313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-201-3028
-----------------------------------------------------
Fax | 512-337-1906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1934
-----------------------------------------------------
City | KINGSLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78639-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-613-5008
-----------------------------------------------------
Fax | 512-337-1906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MRS. SANDRA R GALYON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 830-613-5008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------