Healthcare Provider Details

I. General information

NPI: 1518721794
Provider Name (Legal Business Name): USSAMA TAHA COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 MENCHACA RD STE 806
AUSTIN TX
78748-5379
US

IV. Provider business mailing address

5900 BALCONES DR # 16741
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 512-256-0619
  • Fax:
Mailing address:
  • Phone: 512-256-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: USSAMA TAHA
Title or Position: OWNER
Credential: LCSW
Phone: 512-256-0619