MEDICARE: HILL COUNTRY CHRISTIAN COUNSELING CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	18662	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0037GT	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7636153	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1366440737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILL COUNTRY CHRISTIAN COUNSELING CENTER, INC.

Provider Business Mailing Address
First Line	:	1127 MAIN ST STE 100
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-3581
Country	:	US
Telephone Number	:	830-257-3009
Fax Number	:	830-257-3061

Provider Business Practice Location Address
First Line	:	1127 MAIN ST STE 100
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-3581
Country	:	US
Telephone Number	:	830-257-3009
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BRENDA FUDGE
Credential	:	DIRECTOR
Telephone Number	:	830-257-3009

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	02/12/2019

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