Provider Demographics
NPI:1194040709
Name:MISCHCA T. SCALES, PHD, PLLC
Entity Type:Organization
Organization Name:MISCHCA T. SCALES, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MISCHCA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCALES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-507-6342
Mailing Address - Street 1:7417 TURNBUOY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-4333
Mailing Address - Country:US
Mailing Address - Phone:512-507-6342
Mailing Address - Fax:512-531-9271
Practice Address - Street 1:111 N HASLER BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3831
Practice Address - Country:US
Practice Address - Phone:512-507-6342
Practice Address - Fax:512-531-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161254101Medicaid
TX86843AOtherBLUE CROSS BLUE SHIELD
TX600663363OtherBLUE CROSS BLUE SHIELD
TX8B1713Medicare PIN