Organization
DEEP TIDES THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORINA WOLFENSTEIN (OWNER OF ENTITY)
(503) 754-2817
Entity
Organization
Contact information
Practice address
1804 E 18TH ST, GEORGETOWN, TX 78626-7322
(503) 754-2817
Mailing address
14205 N MO PAC EXPY STE 570, AUSTIN, TX 78728-6529
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
02/24/2025
Last updated
02/24/2025
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