Provider Demographics
NPI:1225351794
Name:GEORGETOWN PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:GEORGETOWN PSYCHOTHERAPY, PLLC
Other - Org Name:PINEY WOODS PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:KROLL
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:936-462-8577
Mailing Address - Street 1:518 E HOSPITAL STREET
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961
Mailing Address - Country:US
Mailing Address - Phone:936-462-8577
Mailing Address - Fax:936-228-9072
Practice Address - Street 1:518 E HOSPITAL STREET
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:936-462-8577
Practice Address - Fax:936-228-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty