Healthcare Provider Details

I. General information

NPI: 1194596601
Provider Name (Legal Business Name): MICHELLE SACKSTEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ROUND ROCK WEST DR STE 606
ROUND ROCK TX
78681-5005
US

IV. Provider business mailing address

600 ROUND ROCK WEST DR STE 606
ROUND ROCK TX
78681-5005
US

V. Phone/Fax

Practice location:
  • Phone: 512-270-1511
  • Fax: 512-631-1606
Mailing address:
  • Phone: 512-270-1511
  • Fax: 512-631-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: