Provider Demographics
NPI:1003566407
Name:INTROSPECTIVE COUNSELING, PLLC
Entity Type:Organization
Organization Name:INTROSPECTIVE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NOHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-505-4612
Mailing Address - Street 1:4301W WILLIAM CANNON DR
Mailing Address - Street 2:STE B-150-254
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:312-505-4612
Mailing Address - Fax:
Practice Address - Street 1:4301W WILLIAM CANNON DR
Practice Address - Street 2:STE B-150-254
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:312-505-4612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty