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General NPI Number Information
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NPI Number | 1174898910
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Entity Type | Organization
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Legal Business Name | EYE OF THE HEART, PA
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 4403 MANCHACA RD SUITE D
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City | AUSTIN
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State | TX
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Zip | 78745-1680
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Country | US
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Telephone | 512-297-8717
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Fax | 888-395-2986
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Provider Business Mailing Address
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Address Line | 4403 MANCHACA RD SUITE D
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City | AUSTIN
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State | TX
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Zip | 78745-1680
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Country | US
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Telephone | 512-297-8717
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Fax | 888-395-2986
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | ALISA MONIQUE CARR
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Credential |
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Telephone | 512-297-8717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 27129
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License Number State | TX
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