Healthcare Provider Details

I. General information

NPI: 1639699754
Provider Name (Legal Business Name): INTEGRITY PSYCHOLOGY OF AUSTIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 E WHITESTONE BLVD STE 260
CEDAR PARK TX
78613-2284
US

IV. Provider business mailing address

1307B N CUERNAVACA DR
AUSTIN TX
78733-2637
US

V. Phone/Fax

Practice location:
  • Phone: 512-309-5555
  • Fax:
Mailing address:
  • Phone: 305-978-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number35130
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number35130
License Number StateTX

VIII. Authorized Official

Name: PAUL S WACHOWIAK
Title or Position: OWNER, PSYCHOLOGIST
Credential: PHD
Phone: 305-978-3670