Healthcare Provider Details

I. General information

NPI: 1437491560
Provider Name (Legal Business Name): AUSTIN RESTORATIVE THERAPIES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6448 E HWY 290 BLDG. E SUITE 114
AUSTIN TX
78723-1068
US

IV. Provider business mailing address

6448 E HWY 290 BLDG. E SUITE 114
AUSTIN TX
78723-1068
US

V. Phone/Fax

Practice location:
  • Phone: 512-520-9384
  • Fax: 267-867-3811
Mailing address:
  • Phone: 512-520-9384
  • Fax: 267-867-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. VANESSA LYNN LONGORIA-CARTER
Title or Position: CO-OWNER
Credential: LPC, LMFTA
Phone: 512-537-3093