Healthcare Provider Details

I. General information

NPI: 1154663516
Provider Name (Legal Business Name): DAVID SORRELLS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID WAYNE SORRELLS LPC

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 08/21/2025
Certification Date:
Deactivation Date: 10/18/2018
Reactivation Date: 08/21/2025

III. Provider practice location address

1631 E 2ND ST STE E
AUSTIN TX
78702-4491
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3650
  • Fax: 512-476-0217
Mailing address:
  • Phone: 512-472-4357
  • Fax: 512-703-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: