Provider Demographics
NPI:1073884540
Name:SEVILLA, COLLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 SPICEWOOD SPRINGS RD STE 3-200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7841
Mailing Address - Country:US
Mailing Address - Phone:512-745-1779
Mailing Address - Fax:
Practice Address - Street 1:4601 SPICEWOOD SPRINGS RD STE 3-200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7841
Practice Address - Country:US
Practice Address - Phone:512-745-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-15
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35055103TC0700X
VA0810004935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical