Healthcare Provider Details

I. General information

NPI: 1063136661
Provider Name (Legal Business Name): REALIGN COUNSELING & PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

IV. Provider business mailing address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

V. Phone/Fax

Practice location:
  • Phone: 972-704-1355
  • Fax:
Mailing address:
  • Phone: 972-704-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DENISE LUCERO-MILLER
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 972-704-1355