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General NPI Number Information
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NPI Number | 1215637467
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Entity Type | Organization
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Legal Business Name | NICOLAS CARRASCO, PHD., INC.
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 314 E HIGHLAND MALL BLVD STE 252
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City | AUSTIN
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State | TX
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Zip | 78752-3766
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Country | US
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Telephone | 512-845-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 502 COQUINA LN
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-4503
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Country | US
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Telephone | 512-845-2400
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | NICOLAS CARRASCO
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Credential | PHD
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Telephone | 512-845-7105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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