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General NPI Number Information
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NPI Number | 1013452663
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Entity Type | Organization
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Legal Business Name | ART FULL LIFE AUSTIN PLLC
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 1101 ARROW POINT DR STE 207
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City | CEDAR PARK
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State | TX
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Zip | 78613-7739
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Country | US
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Telephone | 512-636-9838
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 LITTLE ELM PARK
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City | AUSTIN
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State | TX
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Zip | 78758-6712
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Country | US
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Telephone | 512-636-9838
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ALICE E GREEN
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Credential | LPC AT/S, ATR-BC
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Telephone | 512-636-9838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 15229
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License Number State | TX
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