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General NPI Number Information
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NPI Number | 1083080931
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Entity Type | Organization
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Legal Business Name | JASON SUGG PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 601 W 18TH ST
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City | AUSTIN
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State | TX
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Zip | 78701-1111
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Country | US
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Telephone | 512-354-1046
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Fax |
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Provider Business Mailing Address
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Address Line | 601 W 18TH ST
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City | AUSTIN
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State | TX
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Zip | 78701-1111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON SUGG
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Credential |
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Telephone | 512-659-0985
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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 | 69672
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License Number State | TX
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