=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578069894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILL COUNTRY PLAY THERAPY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2018
-----------------------------------------------------
Last Update Date | 04/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 819 WATER ST STE 106
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-5343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-238-0545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 819 WATER ST STE 106
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-5343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-238-0545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | DR. APRIL GAROFANO BROWN
-----------------------------------------------------
Credential | PHD, LPC-S, RPT-S
-----------------------------------------------------
Telephone | 210-238-0545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | 65889
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------