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General NPI Number Information
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NPI Number | 1518402916
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Entity Type | Organization
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Legal Business Name | CANDICE ACKERMAN, PHD, PLLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 1017 RR 620 S SUITE 222
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City | LAKEWAY
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State | TX
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Zip | 78734
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Country | US
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Telephone | 512-237-7326
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 RR 620 S SUITE 222
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City | LAKEWAY
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State | TX
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Zip | 78734
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Country | US
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Telephone | 512-237-7326
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. CANDICE ACKERMAN
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Credential | PH.D.
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Telephone | 512-596-1306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 74351
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 23301
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11431
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202617
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 70504
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 36802
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License Number State | TX
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