MEDICARE: DR. COLLEEN SEVILLA PSY.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810004935	VA
2	103TC0700X	Clinical Psychologist	35055	TX

General Provider Information

NPI Number	:	1073884540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN SEVILLA PSY.D.

Provider Business Mailing Address
First Line	:	4131 SPICEWOOD SPRINGS RD STE C7
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8658
Country	:	US
Telephone Number	:	512-745-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131 SPICEWOOD SPRINGS RD STE C7
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8658
Country	:	US
Telephone Number	:	512-745-1779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2012
Last Update Date	:	06/04/2026

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