# S'D'K SHOP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891544375
- **Authorized official:** LATONYA HOLLAND (OWNER)
- **Authorized official phone:** (737) 326-5315

## Contact information

- **Practice address:** 12621 HYMEADOW DR RM 331, AUSTIN, TX 78729-2700
- **Practice address phone:** (737) 326-5315
- **Mailing address:** 12621 HYMEADOW DR RM 331, AUSTIN, TX 78729-2700
- **Mailing address phone:** (737) 326-5315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/16/2024
- **Last updated:** 05/16/2024