Healthcare Provider Details

I. General information

NPI: 1093363962
Provider Name (Legal Business Name): ENTEAVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 N MOPAC EXPY STE 604
AUSTIN TX
78759-8347
US

IV. Provider business mailing address

9631 COVEY RIDGE LN
AUSTIN TX
78758-5818
US

V. Phone/Fax

Practice location:
  • Phone: 512-350-6236
  • Fax: 512-792-4862
Mailing address:
  • Phone: 512-748-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ADAM PAINE
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 512-748-6127