Healthcare Provider Details

I. General information

NPI: 1083587448
Provider Name (Legal Business Name): FOX LEAF THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 27672
AUSTIN TX
78731-4257
US

IV. Provider business mailing address

5900 BALCONES DR STE 27672
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 512-643-2392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TOMI YAMAMOTO
Title or Position: OWNER
Credential:
Phone: 512-643-2392