Healthcare Provider Details

I. General information

NPI: 1437468600
Provider Name (Legal Business Name): ALLEN KOFI APPIAH-BOATENG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 QUICK HILL ROAD APT 9307
AUSTIN TX
78728-1285
US

IV. Provider business mailing address

PO BOX 5823
ROUND ROCK TX
78683-5823
US

V. Phone/Fax

Practice location:
  • Phone: 512-547-6193
  • Fax: 866-496-5011
Mailing address:
  • Phone: 512-547-6193
  • Fax: 866-496-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75908
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: