Healthcare Provider Details

I. General information

NPI: 1205204955
Provider Name (Legal Business Name): AUSTIN PSYCHIATRY & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 LYDIA ST
AUSTIN TX
78702
US

IV. Provider business mailing address

2407 S CONGRESS AVE SUITE E#405
AUSTIN TX
78704-5505
US

V. Phone/Fax

Practice location:
  • Phone: 512-766-8650
  • Fax:
Mailing address:
  • Phone: 512-766-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberN7543
License Number StateTX

VIII. Authorized Official

Name: VICTOR M GARZA
Title or Position: SOLE MEMBER
Credential: MD
Phone: 512-766-8650