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General NPI Number Information
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NPI Number | 1962115501
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Entity Type | Organization
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Legal Business Name | WILLIAMSBURG THERAPY GROUP AUSTIN PLLC
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 2121 S LAMAR BLVD STE 200
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City | AUSTIN
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State | TX
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Zip | 78704-4948
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Country | US
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Telephone | 718-757-7033
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 S LAMAR BLVD STE 200
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City | AUSTIN
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State | TX
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Zip | 78704-4948
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Country | US
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Telephone | 718-757-7033
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. DANIEL SELLING
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Credential | PSY.D.
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Telephone | 718-757-7033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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