Healthcare Provider Details

I. General information

NPI: 1326750712
Provider Name (Legal Business Name): JONATHAN DEAN LPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N LAMAR BLVD
AUSTIN TX
78751-1820
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-483-5800
  • Fax:
Mailing address:
  • Phone: 512-472-4357
  • Fax: 512-703-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: