=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184078529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I FEEL I WANT THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2016
-----------------------------------------------------
Last Update Date | 05/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11806 KNOLLPARK DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-3821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-825-0564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11806 KNOLLPARK DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-3821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-282-5056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH M. HEASTON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 512-825-0564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------