Provider Demographics
| NPI: | 1346414869 |
|---|---|
| Name: | PRESTON HOLLOW PSYCHOTHERAPY GROUP |
| Entity Type: | Organization |
| Organization Name: | PRESTON HOLLOW PSYCHOTHERAPY GROUP |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | LICENSED PROFESSIONAL COUNSELOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | AARON |
| Authorized Official - Middle Name: | BENJAMIN |
| Authorized Official - Last Name: | JACOBS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | NCC, LPC |
| Authorized Official - Phone: | 214-350-7289 |
| Mailing Address - Street 1: | 4347 W NORTHWEST HWY |
| Mailing Address - Street 2: | SUITE 120-162 |
| Mailing Address - City: | DALLAS |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 75220-3864 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 214-350-7289 |
| Mailing Address - Fax: | 214-350-7289 |
| Practice Address - Street 1: | 4406 MIDDLETON RD |
| Practice Address - Street 2: | |
| Practice Address - City: | DALLAS |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 75229-6324 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 214-350-7289 |
| Practice Address - Fax: | 214-350-7289 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2008-04-16 |
| Last Update Date: | 2008-04-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | 62024 | 101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 103G00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TH0100X, 103TP2701X, 106H00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty |
