Provider Demographics
NPI:1396135745
Name:SPILLAR COUNSELING SERVICES
Entity type:Organization
Organization Name:SPILLAR COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-923-2987
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:78947-0476
Mailing Address - Country:US
Mailing Address - Phone:512-923-2987
Mailing Address - Fax:
Practice Address - Street 1:2391 COUNTY ROAD 405
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TX
Practice Address - Zip Code:78947-4941
Practice Address - Country:US
Practice Address - Phone:512-923-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty