MEDICARE: HYDE PARK COUNSELING CENTER

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	101YP2500X	Professional Counselor	67586	TX

General Provider Information

NPI Number	:	1265876965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYDE PARK COUNSELING CENTER

Provider Business Mailing Address
First Line	:	3901 SPEEDWAY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-4625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 SPEEDWAY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-4625
Country	:	US
Telephone Number	:	512-451-2186
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. GLORIA MANN
Credential	:
Telephone Number	:	512-451-2186

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/24/2013

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