MEDICARE: YOUNG WOMENS CHRISTIAN ASSOCIATION OF GREATER AUSTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	174400000X	Specialist

General Provider Information

NPI Number	:	1053942219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG WOMENS CHRISTIAN ASSOCIATION OF GREATER AUSTIN

Provider Business Mailing Address
First Line	:	2015 S INTERSTATE 35 STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78741-3810
Country	:	US
Telephone Number	:	512-777-9292
Fax Number	:	512-326-1395

Provider Business Practice Location Address
First Line	:	2015 S INTERSTATE 35 STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78741-3810
Country	:	US
Telephone Number	:	512-326-1222
Fax Number	:	512-326-1395

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BERNARDA NAYA DIAZ
Credential	:
Telephone Number	:	512-326-1222

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	06/21/2022

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