MEDICARE: BRITTNEY ROBERTS PSYCHOTHERAPY, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1487299756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRITTNEY ROBERTS PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	5304 WOODROW AVE # A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2107
Country	:	US
Telephone Number	:	512-522-4783
Fax Number	:

Provider Business Practice Location Address
First Line	:	5304 WOODROW AVE # A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2107
Country	:	US
Telephone Number	:	512-522-4783
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRITTNEY ROBERTS
Credential	:	LCSW
Telephone Number	:	512-522-4783

Provider Enumeration Date	:	11/11/2019
Last Update Date	:	01/24/2020

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