MEDICARE: AEGIS WELLNESS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1851930598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEGIS WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2222 WESTERN TRAILS BLVD STE 107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1601
Country	:	US
Telephone Number	:	512-831-7008
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 WESTERN TRAILS BLVD STE 107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1601
Country	:	US
Telephone Number	:	512-831-7008
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER & CEO
Name	:	RENE JAVIER GAITAN
Credential	:	LCSW-S
Telephone Number	:	512-831-7008

Provider Enumeration Date	:	12/28/2019
Last Update Date	:	12/28/2019

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