Healthcare Provider Details

I. General information

NPI: 1780132167
Provider Name (Legal Business Name): JAVIER ESCOBAR III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 N GEORGETOWN ST
ROUND ROCK TX
78664-3289
US

IV. Provider business mailing address

1009 N GEORGETOWN ST
ROUND ROCK TX
78664-3289
US

V. Phone/Fax

Practice location:
  • Phone: 512-255-1720
  • Fax: 512-597-2141
Mailing address:
  • Phone: 512-255-1720
  • Fax: 512-597-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number69185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: