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General NPI Number Information
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NPI Number | 1962164855
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Entity Type | Organization
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Legal Business Name | PSYCH ETCETERA LLC
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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Country | US
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Telephone | 713-927-0145
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 N FM 620 RD APT 2335
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City | AUSTIN
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State | TX
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Zip | 78726-3569
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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 | MANAGING MEMBER
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Name | REGINALD GRAVES
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Credential | MSN-PMHNP
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Telephone | 713-927-0145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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