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General NPI Number Information
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NPI Number | 1568957108
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Entity Type | Organization
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Legal Business Name | AUSTIN SPIRIT HEART MIND & BODY, LLC
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 6633 E HIGHWAY 290 STE 212
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City | AUSTIN
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State | TX
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Zip | 78723-1111
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Country | US
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Telephone | 512-947-7930
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 KENNEDY GRACE LN
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City | AUSTIN
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State | TX
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Zip | 78728-3502
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Country | US
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Telephone | 512-947-7930
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | LINA CECILIA NAVAR
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Credential | LPC
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Telephone | 512-947-7930
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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 | 75807
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License Number State | TX
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