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General NPI Number Information
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NPI Number | 1538678123
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Entity Type | Organization
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Legal Business Name | SICKLE CELL TEXAS MARC THOMAS FOUNDATION
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 314 E HIGHLAND MALL BLVD STE 411
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City | AUSTIN
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State | TX
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Zip | 78752-3732
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Country | US
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Telephone | 512-458-9767
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Fax | 512-458-9714
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Provider Business Mailing Address
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Address Line | 314 E HIGHLAND MALL BLVD STE 411
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City | AUSTIN
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State | TX
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Zip | 78752-3732
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Country | US
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Telephone | 512-458-9767
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Fax | 512-458-9714
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. EMILY JANINE O'SHEA
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Credential | LCSW
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Telephone | 512-458-9767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 36583
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License Number State | TX
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