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General NPI Number Information
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NPI Number | 1831527985
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Entity Type | Organization
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Legal Business Name | MUSTARD SEED JOURNEYS, P. A.
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 1912 AVENUE R
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City | HONDO
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State | TX
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Zip | 78861-2325
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Country | US
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Telephone | 210-218-2152
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 AVENUE R
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City | HONDO
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State | TX
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Zip | 78861-2325
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Country | US
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Telephone | 210-218-2152
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLIE HAYES
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Credential | PHD, LMFT
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Telephone | 210-218-2152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201353
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License Number State | TX
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