Provider Demographics
NPI:1043800576
Name:HEART OF GYPSY COUNSELING SERVICES
Entity Type:Organization
Organization Name:HEART OF GYPSY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SIMONICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC
Authorized Official - Phone:512-690-4658
Mailing Address - Street 1:3550 LAKELINE BLVD STE 170-1229
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3504
Mailing Address - Country:US
Mailing Address - Phone:512-690-4658
Mailing Address - Fax:
Practice Address - Street 1:201 HIGHLAND OAKS
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3999
Practice Address - Country:US
Practice Address - Phone:512-964-8954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX56720OtherLICENSED CLINICAL SOCIAL WORKER
TX12397OtherLICENSED CHEMICAL DEPENDENCY COUNSELOR