MEDICARE: AUSTIN PSYCHIATRY & WELLNESS PLLC

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	261QM0850X	Adult Mental Health Clinic/Center	N7543	TX

General Provider Information

NPI Number	:	1205204955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN PSYCHIATRY & WELLNESS PLLC

Provider Business Mailing Address
First Line	:	2407 S CONGRESS AVE
Second Line	:	SUITE E#405
City	:	AUSTIN
State	:	TX
Zip	:	78704-5505
Country	:	US
Telephone Number	:	512-766-8650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1154 LYDIA ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702
Country	:	US
Telephone Number	:	512-766-8650
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	VICTOR M GARZA
Credential	:	MD
Telephone Number	:	512-766-8650

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/11/2015

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