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General NPI Number Information
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NPI Number | 1457725624
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGY CENTER OF AUSTIN, PLLC
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 4425 S MOPAC EXPY BLDG. 3 STE. 502
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City | AUSTIN
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State | TX
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Zip | 78735
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Country | US
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Telephone | 512-553-1563
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 SOUTH MOPAC EXPRESSWAY BLDG 3 STE 502
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City | AUSTIN
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State | TX
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Zip | 78735
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Country | US
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Telephone | 512-553-1563
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SARAH GRIESEMER
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Credential |
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Telephone | 512-553-1563
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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 | 34831
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License Number State | TX
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