MEDICARE: DR. ASA R SPHAR III PH.D., LPC, LMFT

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	1572	LA
2	101YM0800X	Mental Health Counselor	62915	TX
3	106H00000X	Marriage & Family Therapist	201142	TX

General Provider Information

NPI Number	:	1174551451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASA R SPHAR III PH.D., LPC, LMFT

Provider Business Mailing Address
First Line	:	2499 S CAPITAL OF TEXAS HWY
Second Line	:	BUILDING A; SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78746-7762
Country	:	US
Telephone Number	:	512-351-4933
Fax Number	:	512-301-5559

Provider Business Practice Location Address
First Line	:	11409 ARCHSTONE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78739-1907
Country	:	US
Telephone Number	:	512-810-9022
Fax Number	:	512-301-5559

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	04/06/2010

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