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General NPI Number Information
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NPI Number | 1609682806
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Entity Type | Individual
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Provider Name | UTKALA MARINGANTI LMFT-A
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Gender | Female
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 311 RANCH ROAD 620 S STE 103
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City | LAKEWAY
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State | TX
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Zip | 78734-4747
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Country | US
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Telephone | 512-766-9911
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 SUNSET VISTA CIR
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City | SPICEWOOD
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State | TX
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Zip | 78669-2086
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Country | US
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Telephone | 650-309-2210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 205322
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License Number State | TX
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