MEDICARE: EQUINE THERAPY AT MCCORMICK RANCH PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YS0200X	School Counselor
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1427906700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUINE THERAPY AT MCCORMICK RANCH PLLC

Provider Business Mailing Address
First Line	:	19926 PARK HOLW
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-1924
Country	:	US
Telephone Number	:	210-854-5380
Fax Number	:

Provider Business Practice Location Address
First Line	:	14350 NORTHBROOK DR STE 130
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5011
Country	:	US
Telephone Number	:	210-854-5380
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HAZIEL M WILLIAMS
Credential	:	LPC
Telephone Number	:	210-854-5380

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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