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General NPI Number Information
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NPI Number | 1720803596
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Entity Type | Individual
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Provider Name | JANE CHALLGREN
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4408 SPICEWOOD SPRINGS RD
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City | AUSTIN
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State | TX
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Zip | 78759-8504
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Country | US
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Telephone | 512-655-3878
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 SHORE DISTRICT DR APT 1113
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City | AUSTIN
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State | TX
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Zip | 78741-1301
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Country | US
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Telephone | 319-504-6609
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 204595
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License Number State | TX
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