Healthcare Provider Details

I. General information

NPI: 1942050158
Provider Name (Legal Business Name): NIAMH FAHY MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5766 BALCONES DR STE 101
AUSTIN TX
78731-4266
US

IV. Provider business mailing address

9002 BLUE HILL CT
AUSTIN TX
78736-7712
US

V. Phone/Fax

Practice location:
  • Phone: 512-580-5812
  • Fax:
Mailing address:
  • Phone: 512-960-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: