Provider Demographics
NPI:1043807506
Name:DR. SOPHY COUNSELING & PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:DR. SOPHY COUNSELING & PSYCHOLOGICAL SERVICES
Other - Org Name:DR. SOPHY COUNSELING & PSYCHOLOGICAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOULOS-SOPHY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-757-2641
Mailing Address - Street 1:11604 SANTA ELENA LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5077
Mailing Address - Country:US
Mailing Address - Phone:512-757-2641
Mailing Address - Fax:
Practice Address - Street 1:4601 SPICEWOOD SPRINGS RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8598
Practice Address - Country:US
Practice Address - Phone:512-467-1376
Practice Address - Fax:512-467-8658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty