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General NPI Number Information
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NPI Number | 1952738486
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Entity Type | Organization
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Legal Business Name | THE AUSTIN CENTER FOR GRIEF AND LOSS
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 2413 GREENLAWN PKWY
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City | AUSTIN
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State | TX
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Zip | 78757-2126
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Country | US
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Telephone | 512-472-7878
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Fax | 512-467-1111
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Provider Business Mailing Address
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Address Line | 2413 GREENLAWN PKWY
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City | AUSTIN
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State | TX
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Zip | 78757-2126
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Country | US
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Telephone | 512-472-7878
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Fax | 512-467-1111
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARY DICKERSON
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Credential |
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Telephone | 512-472-7878
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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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