Provider Demographics
NPI:1598051443
Name:STONE CREEK PSYCHOTHERAPY
Entity Type:Organization
Organization Name:STONE CREEK PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:210-414-7558
Mailing Address - Street 1:8207 CALLAGHAN RD
Mailing Address - Street 2:STE. 425
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4735
Mailing Address - Country:US
Mailing Address - Phone:210-414-7558
Mailing Address - Fax:281-398-9719
Practice Address - Street 1:8207 CALLAGHAN RD
Practice Address - Street 2:STE. 425
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4735
Practice Address - Country:US
Practice Address - Phone:210-414-7558
Practice Address - Fax:281-398-9719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONE CREEK PSYCHOTHERAPY (KATY, TX LOCATION)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53037104100000X
TXS043521041C0700X
TXS067141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty