Healthcare Provider Details

I. General information

NPI: 1124209937
Provider Name (Legal Business Name): MARY LEE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 LAMAR SQUARE DRIVE
AUSTIN TX
78704-8970
US

IV. Provider business mailing address

1339 LAMAR SQUARE DRIVE
AUSTIN TX
78704-8970
US

V. Phone/Fax

Practice location:
  • Phone: 512-443-5777
  • Fax: 512-444-9949
Mailing address:
  • Phone: 512-443-5777
  • Fax: 512-444-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number120677
License Number StateTX

VIII. Authorized Official

Name: MR. RUSS WALKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 512-443-5777