Healthcare Provider Details

I. General information

NPI: 1134235963
Provider Name (Legal Business Name): NORTHWEST COUNSELING & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 HYMEADOW DR #300
AUSTIN TX
78750-1934
US

IV. Provider business mailing address

12335 HYMEADOW DR #300
AUSTIN TX
78750-1934
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-9355
  • Fax: 512-250-9355
Mailing address:
  • Phone: 512-250-9355
  • Fax: 512-250-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13038
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4933
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number3092-3302
License Number StateTX

VIII. Authorized Official

Name: JOHN C HARVEY
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC-S
Phone: 512-250-9355