| J And M Etccc | |
|
105 E Janis Dr Georgetown TX 78628-3615 | |
| (512) 591-7130 | |
| (512) 591-7130 |
| Full Name | J And M Etccc |
|---|---|
| Speciality | Psychologist - Counseling |
| Location | 105 E Janis Dr, Georgetown, Texas |
| Authorized Official Name and Position | Michael Dave Halligan (CO/OWNER) |
| Authorized Official Contact | 5125917130 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J And M Etccc 105 E Janis Dr Georgetown TX 78628-3615 Ph: (512) 591-7130 | J And M Etccc 105 E Janis Dr Georgetown TX 78628-3615 Ph: (512) 591-7130 |
| NPI Number | 1588898787 |
|---|---|
| Provider Enumeration Date | 05/04/2009 |
| Last Update Date | 05/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588898787 | NPI | - | NPPES |
| 12569 | Other | TX | LICENSED PROFESSIONAL COUNSELOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 12569 (Texas) | Primary |
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