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General NPI Number Information
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NPI Number | 1205204955
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Entity Type | Organization
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Legal Business Name | AUSTIN PSYCHIATRY & WELLNESS PLLC
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 1154 LYDIA ST
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City | AUSTIN
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State | TX
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Zip | 78702
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Country | US
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Telephone | 512-766-8650
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Fax |
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Provider Business Mailing Address
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Address Line | 2407 S CONGRESS AVE SUITE E#405
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City | AUSTIN
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State | TX
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Zip | 78704-5505
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Country | US
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Telephone | 512-766-8650
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | VICTOR M GARZA
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Credential | MD
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Telephone | 512-766-8650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | N7543
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License Number State | TX
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