| Hersom Psychotherapy, Pllc | |
|
1301 S Capital Of Texas Hwy West Lake Hills TX 78746-6574 | |
| (737) 477-9457 | |
| Not Available |
| Full Name | Hersom Psychotherapy, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1301 S Capital Of Texas Hwy, West Lake Hills, Texas |
| Authorized Official Name and Position | Justin I. Hersom (OWNER/EMPLOYEE) |
| Authorized Official Contact | 8323268552 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hersom Psychotherapy, Pllc 107 Nautilus Ave Lakeway TX 78738-1005 Ph: (832) 326-8552 | Hersom Psychotherapy, Pllc 1301 S Capital Of Texas Hwy West Lake Hills TX 78746-6574 Ph: (737) 477-9457 |
| NPI Number | 1770216335 |
|---|---|
| Provider Enumeration Date | 07/01/2022 |
| Last Update Date | 08/01/2022 |
| Certification Date | 08/01/2022 |
| Medicare PECOS PAC ID | 4981086717 |
|---|---|
| Medicare Enrollment ID | O20220726003749 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770216335 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Justin Ivan Hersom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871937078 PECOS PAC ID: 8628380797 Enrollment ID: I20220726003772 |
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