Healthcare Provider Details

I. General information

NPI: 1730970302
Provider Name (Legal Business Name): MARY EBERLEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 SHOAL CREEK BLVD BLDG 4
AUSTIN TX
78757-7591
US

IV. Provider business mailing address

505 E HUNTLAND DR STE 320
AUSTIN TX
78752-3741
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-4501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110458
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: