Healthcare Provider Details

I. General information

NPI: 1922136696
Provider Name (Legal Business Name): JOHN MATTHEW FABIAN PSY.D.,J.D.,LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 W HIGHWAY 290 STE 110
AUSTIN TX
78735-8719
US

IV. Provider business mailing address

5716 W HIGHWAY 290 STE 110
AUSTIN TX
78735-8719
US

V. Phone/Fax

Practice location:
  • Phone: 512-831-6551
  • Fax:
Mailing address:
  • Phone: 512-831-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number5756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: