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General NPI Number Information
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NPI Number | 1699579946
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Entity Type | Organization
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Legal Business Name | PRESTIGIOUS GUIDANCE SERVICES, PLLC
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 119 STONE FORK LN
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City | HUTTO
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State | TX
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Zip | 78634-2216
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Country | US
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Telephone | 512-567-7012
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Fax |
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Provider Business Mailing Address
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Address Line | 6507 W HWY 290 STE 607
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City | AUSTIN
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State | TX
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Zip | 78735
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Country | US
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Telephone | 512-843-5169
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. DENIECE LACELL RUSSELL-MCADORY
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Credential | NURSE PRACTITIONER
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Telephone | 512-567-7012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 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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