=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558759134
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSESSMENT & COUNSELING CENTER OF AUSTIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2015
-----------------------------------------------------
Last Update Date | 01/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4413 SPICEWOOD SPRINGS RD #110
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-8580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-922-7664
-----------------------------------------------------
Fax | 512-450-0389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4413 SPICEWOOD SPRINGS RD #110
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-8580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-922-7664
-----------------------------------------------------
Fax | 512-450-0389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | DARLA D ABSHER
-----------------------------------------------------
Credential | LPC-S
-----------------------------------------------------
Telephone | 512-922-7664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 62089
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------