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General NPI Number Information
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NPI Number | 1487087466
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Entity Type | Organization
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Legal Business Name | KATIE JOY WINER, LLC
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 8700 MANCHACA RD SUITE 102
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City | AUSTIN
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State | TX
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Zip | 78748-5371
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Country | US
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Telephone | 512-650-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 MANCHACA RD SUITE 102
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City | AUSTIN
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State | TX
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Zip | 78748-5371
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Country | US
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Telephone | 512-650-8118
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | KATIE JOY WINER
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Credential | LPC, EAGALA
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Telephone | 512-650-8118
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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 | 65809
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License Number State | TX
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