Healthcare Provider Details

I. General information

NPI: 1750558359
Provider Name (Legal Business Name): HYDE PARK COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST SUITE E-2
AUSTIN TX
78705-1121
US

IV. Provider business mailing address

711 W 38TH ST SUITE E-2
AUSTIN TX
78705-1121
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-2186
  • Fax: 512-451-1950
Mailing address:
  • Phone: 512-451-2186
  • Fax: 512-451-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11813
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16033
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33075
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33153
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number32308
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number32587
License Number StateTX

VIII. Authorized Official

Name: DR. NICOLE DANYON FITZPATRICK
Title or Position: DIRECTOR
Credential: PH.D
Phone: 512-451-2186