MEDICARE: PEGASUS COUNSELING

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1104432319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEGASUS COUNSELING

Provider Business Mailing Address
First Line	:	1823 FORTVIEW RD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7663
Country	:	US
Telephone Number	:	512-710-5655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 FORTVIEW RD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7663
Country	:	US
Telephone Number	:	512-710-5655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN ROBERT HORTON-YOUNG
Credential	:	LPC-S
Telephone Number	:	512-710-5655

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	11/10/2020

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Directions to “PEGASUS COUNSELING ” Practice Location

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