Organization
BLUE WATER THERAPISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL MARIE INGERSOLL LCSW (MANAGING MEMBER)
(830) 730-2705
Entity
Organization
Contact information
Practice address
1010 BLUE WATER DR, CANYON LAKE, TX 78133-5584
(830) 730-2705
Mailing address
1010 BLUE WATER DR, CANYON LAKE, TX 78133-5584
(808) 489-5438
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/12/2024
Last updated
08/12/2024
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