Healthcare Provider Details

I. General information

NPI: 1497477954
Provider Name (Legal Business Name): BRIDGES ACADEMY AUSTIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N QUINLAN PARK RD STE 250
AUSTIN TX
78732-6088
US

IV. Provider business mailing address

2900 N QUINLAN PARK RD STE 250
AUSTIN TX
78732-6088
US

V. Phone/Fax

Practice location:
  • Phone: 512-506-1980
  • Fax: 512-387-9734
Mailing address:
  • Phone: 512-506-1980
  • Fax: 512-387-9734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA ELLIOT
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD, LP
Phone: 512-506-1980