Healthcare Provider Details

I. General information

NPI: 1932438405
Provider Name (Legal Business Name): WESTLAKE PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2009
Last Update Date: 12/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CAPITAL OF TEXAS HWY SUITE C-130
WEST LAKE HILLS TX
78746-6574
US

IV. Provider business mailing address

1921 KENWOOD AVE
AUSTIN TX
78704-3633
US

V. Phone/Fax

Practice location:
  • Phone: 512-917-1307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32520
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number32520
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number32520
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number32520
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number32520
License Number StateTX

VIII. Authorized Official

Name: DR. MELISSA MICHELLE MOHLMAN
Title or Position: OWNER
Credential: PH.D.
Phone: 512-917-1307