Provider Demographics
NPI:1972654820
Name:HIGHLAND LAKES BEHAVIORAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:HIGHLAND LAKES BEHAVIORAL MEDICINE, PLLC
Other - Org Name:COVE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:830-265-4554
Mailing Address - Street 1:1001 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5227
Mailing Address - Country:US
Mailing Address - Phone:830-265-4554
Mailing Address - Fax:866-602-0977
Practice Address - Street 1:1007 WEST HIGHWAY 190
Practice Address - Street 2:SUITE B
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522
Practice Address - Country:US
Practice Address - Phone:254-542-7200
Practice Address - Fax:866-602-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11624101YP2500X
TX31593103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty