Provider Demographics
NPI:1164120291
Name:ALTA THERAPY CENTER PLLC
Entity Type:Organization
Organization Name:ALTA THERAPY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CIARYS
Authorized Official - Middle Name:RUBIO
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-366-9561
Mailing Address - Street 1:3440 RANCH TRL APT 2423
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2445
Mailing Address - Country:US
Mailing Address - Phone:323-559-6344
Mailing Address - Fax:
Practice Address - Street 1:3440 RANCH TRL APT 2423
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2445
Practice Address - Country:US
Practice Address - Phone:323-559-6344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health