MEDICARE: TRP WELLNESS, PLLC

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	19467	TX

General Provider Information

NPI Number	:	1811307796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRP WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	1907 N LAMAR BLVD
Second Line	:	351
City	:	AUSTIN
State	:	TX
Zip	:	78705-4992
Country	:	US
Telephone Number	:	512-981-5917
Fax Number	:	512-981-5917

Provider Business Practice Location Address
First Line	:	1907 N LAMAR BLVD
Second Line	:	351
City	:	AUSTIN
State	:	TX
Zip	:	78705-4992
Country	:	US
Telephone Number	:	512-981-5917
Fax Number	:	512-981-5917

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SARAH RIVERS DEAL
Credential	:	PH.D.
Telephone Number	:	512-981-5917

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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