Healthcare Provider Details

I. General information

NPI: 1568055192
Provider Name (Legal Business Name): KOTEL ATX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BEE CAVES RD STE 220
AUSTIN TX
78746-5590
US

IV. Provider business mailing address

3001 BEE CAVES RD STE 220
AUSTIN TX
78746-5590
US

V. Phone/Fax

Practice location:
  • Phone: 855-204-2502
  • Fax:
Mailing address:
  • Phone: 855-204-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHIMENE T PEREZ
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 845-800-8911