Healthcare Provider Details

I. General information

NPI: 1467308452
Provider Name (Legal Business Name): SPICEWOOD OUTPATIENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 SPICEWOOD SPRINGS RD STE 1235
AUSTIN TX
78759-8478
US

IV. Provider business mailing address

4807 SPICEWOOD SPRINGS RD STE 1235
AUSTIN TX
78759-8478
US

V. Phone/Fax

Practice location:
  • Phone: 210-860-2443
  • Fax: 737-221-2477
Mailing address:
  • Phone: 210-860-2443
  • Fax: 737-221-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOE ROLLER
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 512-968-7402