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General NPI Number Information
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NPI Number | 1043807506
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Entity Type | Organization
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Legal Business Name | DR. SOPHY COUNSELING & PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 4601 SPICEWOOD SPRINGS RD STE 200
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City | AUSTIN
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State | TX
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Zip | 78759-8598
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Country | US
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Telephone | 512-467-1376
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Fax | 512-467-8658
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Provider Business Mailing Address
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Address Line | 11604 SANTA ELENA LN
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City | AUSTIN
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State | TX
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Zip | 78717-5077
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Country | US
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Telephone | 512-757-2641
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SALLIE A BOULOS-SOPHY
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Credential | PHD
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Telephone | 512-757-2641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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