MEDICARE: EMERALD PATH COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1700572237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD PATH COUNSELING PLLC

Provider Business Mailing Address
First Line	:	1716 CONSTANTINO CIR UNIT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1716 CONSTANTINO CIR UNIT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4171
Country	:	US
Telephone Number	:	737-232-7439
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	BROOKE BROCKMAN
Credential	:	LPC
Telephone Number	:	737-232-7439

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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