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General NPI Number Information
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NPI Number | 1770070070
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Entity Type | Organization
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Legal Business Name | AUSTIN VITALITY COUNSELING
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 12502 PALFREY DR
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City | AUSTIN
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State | TX
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Zip | 78727-3017
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Country | US
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Telephone | 512-422-4352
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Fax |
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Provider Business Mailing Address
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Address Line | 12502 PALFREY DR
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City | AUSTIN
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State | TX
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Zip | 78727-3017
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Country | US
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Telephone | 512-422-4352
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CARLYE JOHNSTON LEVINE
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Credential | LCSW
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Telephone | 512-422-4352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 52338
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License Number State | TX
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