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General NPI Number Information
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NPI Number | 1679785844
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Entity Type | Organization
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Legal Business Name | LINDA A MAC NEILAGE PHD PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 606 HARTHAN ST
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City | AUSTIN
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State | TX
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Zip | 78703-5216
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Country | US
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Telephone | 512-478-7069
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Fax |
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Provider Business Mailing Address
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Address Line | 606 HARTHAN ST
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City | AUSTIN
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State | TX
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Zip | 78703-5216
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Country | US
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Telephone | 512-478-7069
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LINDA A MAC NEILAGE
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Credential | PHD
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Telephone | 512-478-7069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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