MEDICARE: CAROLYN BLUTHARDT LPA-ASSOCIATE

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	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor	99289	TX

General Provider Information

NPI Number	:	1578159802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN BLUTHARDT LPA-ASSOCIATE

Provider Business Mailing Address
First Line	:	1508 DESHAUN RIDGE LANE
Second Line	:	SUITE 204
City	:	AUSTIN
State	:	TX
Zip	:	78754
Country	:	US
Telephone Number	:	512-270-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 DESHAUN RIDGE LANE
Second Line	:	SUITE 204
City	:	AUSTIN
State	:	TX
Zip	:	78754
Country	:	US
Telephone Number	:	512-270-2309
Fax Number	:

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

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	05/08/2026

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