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General NPI Number Information
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NPI Number | 1114469533
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTRAL AUSTIN
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 4304 MARATHON BLVD
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City | AUSTIN
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State | TX
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Zip | 78756-3427
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Country | US
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Telephone | 512-417-7086
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Fax |
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Provider Business Mailing Address
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Address Line | 4304 MARATHON BLVD
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City | AUSTIN
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State | TX
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Zip | 78756-3427
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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 | FOUNDER, CEO
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Name | GABRIELLE ZANDAN
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Credential | M.A., L.P.C.
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Telephone | 512-417-7086
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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 | 73995
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License Number State | TX
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