MEDICARE: LUCENT OUTPATIENT LLC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1912779232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCENT OUTPATIENT LLC

Provider Business Mailing Address
First Line	:	4807 SPICEWOOD SPRINGS RD STE 1100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4807 SPICEWOOD SPRINGS RD STE 1100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8435
Country	:	US
Telephone Number	:	512-757-7835
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT ROLLER
Credential	:
Telephone Number	:	512-968-7402

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	03/03/2026

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Directions to “LUCENT OUTPATIENT LLC ” Practice Location

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