Healthcare Provider Details

I. General information

NPI: 1851038863
Provider Name (Legal Business Name): EMBODIED ART THERAPY AND COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 N MOPAC EXPY STE 301
AUSTIN TX
78759-8323
US

IV. Provider business mailing address

8400 N MOPAC EXPY STE 301
AUSTIN TX
78759-8323
US

V. Phone/Fax

Practice location:
  • Phone: 512-503-5030
  • 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
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: MALLORY KATHLEEN KEEKS
Title or Position: OWNER/ART THERAPIST AND COUNSELOR
Credential: LPC, ATR
Phone: 512-503-5030