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General NPI Number Information
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NPI Number | 1952020786
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Entity Type | Organization
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Legal Business Name | SPROUTING BRANCH PSYCHOTHERAPY INC
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 1801 W KOENIG LN
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City | AUSTIN
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State | TX
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Zip | 78756-1208
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Country | US
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Telephone | 512-831-7909
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Fax |
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Provider Business Mailing Address
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Address Line | 11919 MEADOWFIRE DR
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City | AUSTIN
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State | TX
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Zip | 78758-3318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | NEISHA HOOTMAN
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Credential | PHD
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Telephone | 512-415-6647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 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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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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