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General NPI Number Information
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NPI Number | 1154525509
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Entity Type | Organization
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Legal Business Name | AUSTIN CENTER FOR THERAPY AND ASSESSMENT
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8103 BRODIE LN SUITE 1
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City | AUSTIN
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State | TX
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Zip | 78745-7473
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Country | US
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Telephone | 512-608-1166
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Fax | 512-448-0499
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Provider Business Mailing Address
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Address Line | 8103 BRODIE LN SUITE 1
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City | AUSTIN
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State | TX
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Zip | 78745-7473
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Country | US
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Telephone | 512-608-1166
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Fax | 512-448-0499
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Authorized Official
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Title or Position | OWNER
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Name | ARON X BAUTISTA
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Credential | LPC
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Telephone | 512-608-1165
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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 | 19839
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License Number State | TX
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