Healthcare Provider Details

I. General information

NPI: 1942765870
Provider Name (Legal Business Name): JAMIE WEHRENBERG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 E RIVERSIDE DR STE G3
AUSTIN TX
78741-3053
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3056
  • Fax: 512-323-9544
Mailing address:
  • Phone: 512-472-4357
  • Fax: 512-703-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number77054
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: