Healthcare Provider Details

I. General information

NPI: 1598556706
Provider Name (Legal Business Name): EMILY SUZANNE PENCIS NONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 W SLAUGHTER LN STE 130
AUSTIN TX
78748-6904
US

IV. Provider business mailing address

1213 W SLAUGHTER LN STE 130
AUSTIN TX
78748-6904
US

V. Phone/Fax

Practice location:
  • Phone: 512-632-9451
  • Fax:
Mailing address:
  • Phone: 512-201-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNONE
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberNONE
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: