| Four Falls Cedar Park Pllc | |
|
500 W Whitestone Blvd Ste 105 Cedar Park TX 78613-2271 | |
| (520) 975-5435 | |
| Not Available |
| Full Name | Four Falls Cedar Park Pllc |
|---|---|
| Speciality | Counselor |
| Location | 500 W Whitestone Blvd Ste 105, Cedar Park, Texas |
| Authorized Official Name and Position | Jason Fallwell (OWNER) |
| Authorized Official Contact | 5209755435 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Falls Cedar Park Pllc 144 Ridgeview Ct Georgetown TX 78628-6026 Ph: (520) 975-5435 | Four Falls Cedar Park Pllc 500 W Whitestone Blvd Ste 105 Cedar Park TX 78613-2271 Ph: (520) 975-5435 |
| NPI Number | 1548966864 |
|---|---|
| Provider Enumeration Date | 02/07/2023 |
| Last Update Date | 02/13/2023 |
| Certification Date | 02/13/2023 |
| Medicare PECOS PAC ID | 5799122727 |
|---|---|
| Medicare Enrollment ID | O20240326001299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548966864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kindra Michelle Gonzalez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326658055 PECOS PAC ID: 5597102525 Enrollment ID: I20240326001917 |
| Provider Name | Jennifer Rose Hodges |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225554942 PECOS PAC ID: 4587001540 Enrollment ID: I20240326002505 |
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