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General NPI Number Information
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NPI Number | 1740658111
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Entity Type | Organization
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Legal Business Name | NORTH EAST THERAPEUTICS, PLLC
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 415 S ELM ST SUITE 101
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City | DENTON
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State | TX
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Zip | 76201-6015
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Country | US
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Telephone | 469-850-2156
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 ROSSON RD
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City | LITTLE ELM
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State | TX
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Zip | 75068-8533
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Country | US
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Telephone | 469-850-2156
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HILLARY NETTERVILLE
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Credential | MS, LPC, NCC
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Telephone | 469-850-2156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 70635
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License Number State | TX
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