Provider Demographics
NPI:1669069639
Name:HEART OF GYPSY COUNSELING SERVICES
Entity type:Organization
Organization Name:HEART OF GYPSY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SIMONICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC
Authorized Official - Phone:512-690-4658
Mailing Address - Street 1:3550 LAKELINE BLVD STE 170-1229
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3504
Mailing Address - Country:US
Mailing Address - Phone:512-690-4658
Mailing Address - Fax:
Practice Address - Street 1:3550 LAKELINE BLVD STE 170-1229
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3504
Practice Address - Country:US
Practice Address - Phone:512-690-4658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1295260693Medicaid