Healthcare Provider Details

I. General information

NPI: 1538699541
Provider Name (Legal Business Name): PATRICIA KOTTARIDIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6102 ASA DR UNIT A
AUSTIN TX
78744-6641
US

IV. Provider business mailing address

6102 ASA DR UNIT A
AUSTIN TX
78744-6641
US

V. Phone/Fax

Practice location:
  • Phone: 720-593-0751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number83388
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: