MEDICARE: IAN BIRDWELL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	65478	TX

General Provider Information

NPI Number	:	1306106976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN BIRDWELL LPC

Provider Business Mailing Address
First Line	:	1003 JUSTIN LN
Second Line	:	#2096
City	:	AUSTIN
State	:	TX
Zip	:	78757-2662
Country	:	US
Telephone Number	:	512-585-2304
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 JUSTIN LN
Second Line	:	#2096
City	:	AUSTIN
State	:	TX
Zip	:	78757-2662
Country	:	US
Telephone Number	:	512-585-2304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/16/2012

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Directions to “ IAN BIRDWELL LPC” Practice Location

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