Provider Demographics
NPI:1508247669
Name:STONE CREEK PSYCHOTHERAPY AND WELLNESS, INC.
Entity Type:Organization
Organization Name:STONE CREEK PSYCHOTHERAPY AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:APPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-767-3925
Mailing Address - Street 1:6500 RIVER PLACE BLVD BLDG 7
Mailing Address - Street 2:SUITES 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1119
Mailing Address - Country:US
Mailing Address - Phone:512-767-3925
Mailing Address - Fax:
Practice Address - Street 1:6500 RIVER PLACE BLVD BLDG 7
Practice Address - Street 2:SUITES 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1119
Practice Address - Country:US
Practice Address - Phone:512-767-3925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONE CREEK PSYCHOTHERAPY AND WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX067141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty