Healthcare Provider Details

I. General information

NPI: 1023325032
Provider Name (Legal Business Name): ZEGEMA PROFESSIONAL RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 FORT VW SUITE 101
AUSTIN TX
78704-7657
US

IV. Provider business mailing address

1825 FORT VW SUITE 101
AUSTIN TX
78704-7657
US

V. Phone/Fax

Practice location:
  • Phone: 512-541-2133
  • Fax:
Mailing address:
  • Phone: 512-541-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34416
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number30636
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN DAVID HUBER SR.
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 512-541-2133