Provider Demographics
NPI:1750626750
Name:HILL, MYLENE (LCDC,CCJP)
Entity type:Individual
Prefix:
First Name:MYLENE
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:LCDC,CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13207 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-5000
Mailing Address - Country:US
Mailing Address - Phone:512-697-8663
Mailing Address - Fax:
Practice Address - Street 1:13207 WRIGHT RD
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-5000
Practice Address - Country:US
Practice Address - Phone:512-697-8663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9463101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)