MEDICARE: IBEN AHRENSBACK DYKE 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	101YP2500X	Professional Counselor	68514	TX

General Provider Information

NPI Number	:	1588357206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBEN AHRENSBACK DYKE LPC

Provider Business Mailing Address
First Line	:	2938 LANTANA RIDGE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-2010
Country	:	US
Telephone Number	:	512-680-8654
Fax Number	:

Provider Business Practice Location Address
First Line	:	2938 LANTANA RIDGE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-2010
Country	:	US
Telephone Number	:	512-680-8654
Fax Number	:

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

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	05/30/2023

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