| Growth Space, Pllc | |
|
5900 Balcones Dr Ste 100 Austin TX 78731-4298 | |
| (915) 703-1415 | |
| (915) 265-0667 |
| Full Name | Growth Space, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 5900 Balcones Dr Ste 100, Austin, Texas |
| Authorized Official Name and Position | Myra L Hernandez (LPC-S) |
| Authorized Official Contact | 9157031415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Growth Space, Pllc 7516 Porterhouse Ct El Paso TX 79911-2244 Ph: (915) 227-4550 | Growth Space, Pllc 5900 Balcones Dr Ste 100 Austin TX 78731-4298 Ph: (915) 703-1415 |
| NPI Number | 1578255246 |
|---|---|
| Provider Enumeration Date | 05/22/2023 |
| Last Update Date | 12/19/2023 |
| Certification Date | 12/19/2023 |
| Medicare PECOS PAC ID | 9830548890 |
|---|---|
| Medicare Enrollment ID | O20231215001531 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578255246 | NPI | - | NPPES |
| 4714040 | Medicaid | TX | |
| 1033322417 | Other | TYPE 1 NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Myra Lisette Hernandez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033322417 PECOS PAC ID: 0749639706 Enrollment ID: I20231215001836 |
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