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General NPI Number Information
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NPI Number | 1750521175
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Entity Type | Organization
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Legal Business Name | BILLWOODBURNLPC, P.C.
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 5758 BALCONES DR STE 102
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City | AUSTIN
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State | TX
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Zip | 78731-4247
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Country | US
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Telephone | 512-458-2875
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Fax |
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Provider Business Mailing Address
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Address Line | 10303 E RUTLAND VLG
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City | AUSTIN
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State | TX
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Zip | 78758-5517
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Country | US
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Telephone | 512-458-2875
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. BILL WOODBURN
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Credential | MED, LPC, LMFT
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Telephone | 512-458-2875
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC 10121
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License Number State | TX
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