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General NPI Number Information
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NPI Number | 1508045287
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Entity Type | Organization
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Legal Business Name | BOULDER CREEK MINISTRIES
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 1009 FALLS PKWY SUITE A
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City | MARBLE FALLS
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State | TX
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Zip | 78654-4630
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Country | US
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Telephone | 830-798-9820
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Fax | 830-798-9820
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Provider Business Mailing Address
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Address Line | 1009 FALLS PKWY SUITE A
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City | MARBLE FALLS
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State | TX
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Zip | 78654-4630
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Country | US
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Telephone | 830-798-9820
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Fax | 830-798-9820
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JULIE GRIFFIN
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Credential | PH.D.
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Telephone | 830-798-9820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11346
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 33159
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License Number State | TX
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