Healthcare Provider Details

I. General information

NPI: 1912506114
Provider Name (Legal Business Name): DANIEL ALLEN MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E SAINT JOHNS AVE
AUSTIN TX
78752-2508
US

IV. Provider business mailing address

4008 CIMA SERENA DR UNIT A
AUSTIN TX
78759-8110
US

V. Phone/Fax

Practice location:
  • Phone: 512-961-5575
  • Fax:
Mailing address:
  • Phone: 512-422-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12074
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: