=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821623596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLUTIONS THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2020
-----------------------------------------------------
Last Update Date | 06/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 CLEARDAY DR APT 110
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78745-5669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-916-9832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6800 W GATE BLVD STE 132 PMB 265
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78745-4868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | KELLEN VON HOUSER
-----------------------------------------------------
Credential | LPC-S
-----------------------------------------------------
Telephone | 512-297-8741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------