Provider Demographics
NPI:1508126020
Name:STONE SPRINGS WELLNESS
Entity Type:Organization
Organization Name:STONE SPRINGS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DANNER
Authorized Official - Last Name:MINNIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-520-7840
Mailing Address - Street 1:3520 VICTORINE LN APT A
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-3032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3520 VICTORINE LN APT A
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3032
Practice Address - Country:US
Practice Address - Phone:512-520-7840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
TXMT111365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty