MEDICARE: AUSTIN RECORERY

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	324500000X	Substance Abuse Rehabilitation Facility	32450000X	TX

General Provider Information

NPI Number	:	1548652910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN RECORERY

Provider Business Mailing Address
First Line	:	3420 EXECUTIVE CENTER DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-1624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 EXECUTIVE CENTER DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-1624
Country	:	US
Telephone Number	:	920-216-8700
Fax Number	:

Authorized Official
Title or Position	:	COLLABORATIVE COUNSELOR
Name	:	CRYSTLYN MROCZENSKI
Credential	:
Telephone Number	:	920-216-8700

Provider Enumeration Date	:	02/23/2015
Last Update Date	:	02/23/2015

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Directions to “AUSTIN RECORERY ” Practice Location

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