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General NPI Number Information
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NPI Number | 1467237842
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Entity Type | Organization
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Legal Business Name | BEACON BEHAVIORAL GTX LLC
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 712 S AUSTIN AVE STE 201
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City | GEORGETOWN
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State | TX
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Zip | 78626-5709
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Country | US
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Telephone | 737-242-0034
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Fax | 512-686-2200
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Provider Business Mailing Address
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Address Line | 4810 SPICEWOOD SPRINGS RD BLDG B
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City | AUSTIN
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State | TX
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Zip | 78759-7845
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Country | US
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Telephone | 512-593-7066
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Fax | 512-593-7066
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Authorized Official
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Title or Position | OWNER
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Name | EMILY KIPP-WRIGHT
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Credential | LPC
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Telephone | 737-242-0034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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