Healthcare Provider Details

I. General information

NPI: 1639426372
Provider Name (Legal Business Name): THERAPY AUSTIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W 51ST ST UNIT 1
AUSTIN TX
78756-2607
US

IV. Provider business mailing address

1415 W 51ST ST UNIT 1
AUSTIN TX
78756-2607
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-4501
  • Fax: 512-201-4502
Mailing address:
  • Phone: 512-201-4501
  • Fax: 512-201-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37929
License Number StateTX

VIII. Authorized Official

Name: MS. DANIELLE HAYES
Title or Position: CO-DIRECTOR
Credential: LCSW
Phone: 512-201-4501