MEDICARE: SPILLAR COUNSELING SERVICES

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	101YP2500X	Professional Counselor	67245	TX

General Provider Information

NPI Number	:	1396135745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPILLAR COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 476
Second Line	:
City	:	LEXINGTON
State	:	TX
Zip	:	78947-0476
Country	:	US
Telephone Number	:	512-923-2987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2391 COUNTY ROAD 405
Second Line	:
City	:	LEXINGTON
State	:	TX
Zip	:	78947-4941
Country	:	US
Telephone Number	:	512-923-2987
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MR. DEREK SPILLAR
Credential	:	LPC
Telephone Number	:	512-923-2987

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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