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NPI Code Detail

MEDICARE: HATTIE M HENDRIX LCDC #14624

MEDICARE: HATTIE M HENDRIX LCDC #14624
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
1101YA0400XAddiction (Substance Use Disorder) Counselor14624TX
2101YP2500XProfessional Counselor91573TX

General Provider Information

NPI Number : 1376970533
Entity Type Code : Individual
Provider Name (Legal Business Name) : HATTIE M HENDRIX LCDC #14624
Provider Business Mailing Address
First Line : 3615 CULEBRA RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78228-5914
Country : US
Telephone Number : 210-314-6473
Fax Number : 210-314-8676
Provider Business Practice Location Address
First Line : 3615 CULEBRA RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78228-5914
Country : US
Telephone Number : 210-314-6473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2013
Last Update Date : 05/14/2025

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