Healthcare Provider Details

I. General information

NPI: 1124577655
Provider Name (Legal Business Name): CHRISTINE KASKOW LPC INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E ANDERSON LN SUITE 120
AUSTIN TX
78752-1236
US

IV. Provider business mailing address

313 E ANDERSON LN SUITE 120
AUSTIN TX
78752-1236
US

V. Phone/Fax

Practice location:
  • Phone: 512-961-5575
  • Fax:
Mailing address:
  • Phone: 512-961-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75484
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: