Healthcare Provider Details

I. General information

NPI: 1346806114
Provider Name (Legal Business Name): RESILIENT MIND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 MEDICAL PKWY STE 320
CEDAR PARK TX
78613-7904
US

IV. Provider business mailing address

7600 WOOD HOLLOW DR APT 122
AUSTIN TX
78731-2242
US

V. Phone/Fax

Practice location:
  • Phone: 512-363-8212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY HUG
Title or Position: LICENCED PROFESSIONAL COUNSELOR
Credential:
Phone: 512-363-8212