Healthcare Provider Details

I. General information

NPI: 1700572237
Provider Name (Legal Business Name): EMERALD PATH COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 CONSTANTINO CIR UNIT B
AUSTIN TX
78745-4171
US

IV. Provider business mailing address

1716 CONSTANTINO CIR UNIT B
AUSTIN TX
78745-4171
US

V. Phone/Fax

Practice location:
  • Phone: 737-232-7439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BROOKE BROCKMAN
Title or Position: COUNSELOR
Credential: LPC
Phone: 737-232-7439