| Georgetown Psychotherapy, Pllc | |
|
518 E Hospital Street Nacogdoches TX 75961 | |
| (936) 462-8577 | |
| (936) 228-9072 |
| Full Name | Georgetown Psychotherapy, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 518 E Hospital Street, Nacogdoches, Texas |
| Authorized Official Name and Position | Sydney Kroll Register (OWNER) |
| Authorized Official Contact | 9364628577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Georgetown Psychotherapy, Pllc 518 E Hospital Street Nacogdoches TX 75961 Ph: (936) 462-8577 | Georgetown Psychotherapy, Pllc 518 E Hospital Street Nacogdoches TX 75961 Ph: (936) 462-8577 |
| NPI Number | 1225351794 |
|---|---|
| Provider Enumeration Date | 03/11/2010 |
| Last Update Date | 06/15/2021 |
| Certification Date | 06/15/2021 |
| Medicare PECOS PAC ID | 2466589411 |
|---|---|
| Medicare Enrollment ID | O20100422000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225351794 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 34032 (Texas) | Primary |
| Provider Name | Sydney Kroll Register |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467638825 PECOS PAC ID: 7719014836 Enrollment ID: I20100422000066 |
| Provider Name | Lauren M Ivy Sieja |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629645155 PECOS PAC ID: 4082018106 Enrollment ID: I20210811000421 |
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