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General NPI Number Information
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NPI Number | 1669069639
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Entity Type | Organization
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Legal Business Name | HEART OF GYPSY COUNSELING SERVICES
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Dates
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Enumeration Date | 12/24/2020
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Last Update Date | 12/24/2020
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Provider Practice Location Address
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Address Line | 3550 LAKELINE BLVD STE 170-1229
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City | LEANDER
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State | TX
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Zip | 78641-3504
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Country | US
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Telephone | 512-690-4658
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Fax |
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Provider Business Mailing Address
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Address Line | 3550 LAKELINE BLVD STE 170-1229
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City | LEANDER
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State | TX
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Zip | 78641-3504
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Country | US
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Telephone | 512-690-4658
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MICHELE LYNN SIMONICH
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Credential | LCSW, LCDC
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Telephone | 512-690-4658
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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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