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General NPI Number Information
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NPI Number | 1053184937
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Entity Type | Individual
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Provider Name | JESSICA LYNN TAUBER
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Gender | Female
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 8500 SHOAL CREEK BLVD STE 4-201A
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City | AUSTIN
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State | TX
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Zip | 78757-7598
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Country | US
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Telephone | 512-253-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 2709 E 14TH ST UNIT B
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City | AUSTIN
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State | TX
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Zip | 78702-1503
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Country | US
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Telephone | 913-205-1234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 39805
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License Number State | TX
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