Healthcare Provider Details

I. General information

NPI: 1184549420
Provider Name (Legal Business Name): HEADWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 500
AUSTIN TX
78731-4257
US

IV. Provider business mailing address

5900 BALCONES DR STE 500
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 915-944-1084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELMER AVALOS
Title or Position: THERAPIST
Credential: LPC-A
Phone: 915-504-8473