Healthcare Provider Details

I. General information

NPI: 1760917785
Provider Name (Legal Business Name): CARMA HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 34TH ST STE 301
AUSTIN TX
78705
US

IV. Provider business mailing address

630 W 34TH ST STE 301
AUSTIN TX
78705-1217
US

V. Phone/Fax

Practice location:
  • Phone: 512-212-4670
  • Fax: 512-233-5830
Mailing address:
  • Phone: 512-212-4670
  • Fax: 512-233-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORIE WIDMAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 512-212-4670