MEDICARE: YOUR PSYCHOLOGIST 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861991242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR PSYCHOLOGIST PLLC

Provider Business Mailing Address
First Line	:	11615 ANGUS RD STE 108
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4064
Country	:	US
Telephone Number	:	512-710-6568
Fax Number	:

Provider Business Practice Location Address
First Line	:	11615 ANGUS RD STE 108
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4064
Country	:	US
Telephone Number	:	512-710-6568
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SWAPNILA S DAS
Credential	:	CP
Telephone Number	:	512-710-6568

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	02/12/2018

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Directions to “YOUR PSYCHOLOGIST PLLC ” Practice Location

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