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General NPI Number Information
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NPI Number | 1467308452
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Entity Type | Organization
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Legal Business Name | SPICEWOOD OUTPATIENT LLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 4807 SPICEWOOD SPRINGS RD STE 1235
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City | AUSTIN
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State | TX
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Zip | 78759-8478
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Country | US
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Telephone | 210-860-2443
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Fax | 737-221-2477
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Provider Business Mailing Address
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Address Line | 4807 SPICEWOOD SPRINGS RD STE 1235
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City | AUSTIN
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State | TX
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Zip | 78759-8478
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Country | US
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Telephone | 210-860-2443
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Fax | 737-221-2477
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JOE ROLLER
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Credential |
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Telephone | 512-968-7402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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