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NPI Code Detail

MEDICARE: COUNSELING FOR PERSONAL GROWTH PLL

MEDICARE: COUNSELING FOR PERSONAL GROWTH PLL
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1619408986
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNSELING FOR PERSONAL GROWTH PLL
Provider Business Mailing Address
First Line : 12335 HYMEADOW DR STE 300
Second Line :
City : AUSTIN
State : TX
Zip : 78750-1935
Country : US
Telephone Number : 512-537-4054
Fax Number :
Provider Business Practice Location Address
First Line : 12335 HYMEADOW DR STE 300
Second Line :
City : AUSTIN
State : TX
Zip : 78750-1935
Country : US
Telephone Number : 512-537-4054
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : SCOTT ROBERTS
Credential :
Telephone Number : 512-537-4054
Provider Enumeration Date : 03/27/2017
Last Update Date : 03/27/2017

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