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General NPI Number Information
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NPI Number | 1568905768
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Entity Type | Organization
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Legal Business Name | PRISM COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 3009 E 4TH ST
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City | AUSTIN
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State | TX
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Zip | 78702-4811
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Country | US
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Telephone | 419-706-8726
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 E. 4TH ST.
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City | AUSTIN
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State | TX
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Zip | 78702
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Country | US
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Telephone | 419-706-8726
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIRANDA SUE CASERO
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Credential |
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Telephone | 512-843-1451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 63208
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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