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NPI Code Detail

MEDICARE: MR. DEREK JEFFREY SPILLAR LPC, LSOTP

MEDICARE:  MR. DEREK JEFFREY SPILLAR  LPC, LSOTP
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
1101YP2500XProfessional Counselor67245TX

General Provider Information

NPI Number : 1912340209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DEREK JEFFREY SPILLAR LPC, LSOTP
Provider Business Mailing 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 :
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2013
Last Update Date : 04/17/2013

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Directions to “ MR. DEREK JEFFREY SPILLAR LPC, LSOTP” Practice Location

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