=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154773000
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUDREY PATRICIA OGORMAN MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2016
-----------------------------------------------------
Last Update Date | 05/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4131 SPICEWOOD SPRINGS RD BUILDING M, UNIT 1
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-656-1950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8701 BLUFFSTONE CV 1108
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-7806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-656-1950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 202034
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 69884
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------