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General NPI Number Information
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NPI Number | 1861032948
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Entity Type | Organization
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Legal Business Name | EXPLORE WELLNESS, PLLC
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 5828 BALCONES DR STE 101
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City | AUSTIN
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State | TX
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Zip | 78731-4279
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Country | US
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Telephone | 512-789-3830
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Fax | 512-852-4634
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Provider Business Mailing Address
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Address Line | 5828 BALCONES DR STE 101
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City | AUSTIN
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State | TX
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Zip | 78731-4279
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Country | US
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Telephone | 512-789-3830
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Fax | 512-852-4634
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA MIHAL
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Credential | LCSW
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Telephone | 512-789-3830
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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 |
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License Number State |
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