Provider Demographics
NPI:1558684274
Name:KILCREASE, JACK WORTH II (LPC)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:WORTH
Last Name:KILCREASE
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:J. WORTH
Other - Middle Name:
Other - Last Name:KILCREASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4833 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7253
Mailing Address - Country:US
Mailing Address - Phone:512-658-2674
Mailing Address - Fax:512-346-0082
Practice Address - Street 1:4833 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7253
Practice Address - Country:US
Practice Address - Phone:512-658-2674
Practice Address - Fax:512-346-0082
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59946101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor