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General NPI Number Information
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NPI Number | 1679863450
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Entity Type | Organization
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Legal Business Name | AUSTIN TRAVIS COUNTY INTEGRAL CARE
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 4019 MANCHACA RD
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City | AUSTIN
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State | TX
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Zip | 78704-6737
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Country | US
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Telephone | 512-804-3414
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Fax | 512-447-2213
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Provider Business Mailing Address
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Address Line | 4019 MANCHACA RD
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City | AUSTIN
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State | TX
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Zip | 78704-6737
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Country | US
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Telephone | 512-804-3414
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Fax | 512-447-2213
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Authorized Official
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Title or Position | DRUG COUNSELOR
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Name | MR. DAVID ALAN KITCHING
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Credential | LCDC
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Telephone | 512-769-8789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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