Provider Demographics
NPI:1043366388
Name:HOSTETLER, PATRICIA KAY (LPC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KAY
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11904 BROAD LEAF CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1390
Mailing Address - Country:US
Mailing Address - Phone:512-627-1396
Mailing Address - Fax:512-250-1396
Practice Address - Street 1:11904 BROAD LEAF CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1390
Practice Address - Country:US
Practice Address - Phone:512-627-1396
Practice Address - Fax:512-250-1396
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11624288OtherCAQH PROVIDER ID
TX156180302Medicaid