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General NPI Number Information
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NPI Number | 1467068247
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Entity Type | Organization
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Legal Business Name | AMPLE AND ROOTED PLLC
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 1700 S LAMAR BLVD STE 338
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City | AUSTIN
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State | TX
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Zip | 78704-3363
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Country | US
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Telephone | 512-759-0595
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 S LAMAR BLVD STE 338
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City | AUSTIN
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State | TX
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Zip | 78704-3363
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Country | US
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Telephone | 915-549-6660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NEATHERY THURMOND
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Credential | LCSW-S, CGP
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Telephone | 125-759-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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