Healthcare Provider Details

I. General information

NPI: 1467926626
Provider Name (Legal Business Name): CARMA SPECIALTY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 34TH ST STE 301A
AUSTIN TX
78705-1232
US

IV. Provider business mailing address

630 W 34TH ST STE 301A
AUSTIN TX
78705-1232
US

V. Phone/Fax

Practice location:
  • Phone: 832-289-9225
  • Fax:
Mailing address:
  • Phone: 832-289-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: TYLER PENROD
Title or Position: CTO
Credential:
Phone: 832-289-9225