Provider Demographics
NPI:1326410424
Name:WAISANEN, ALAN GEORGE (MS, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:GEORGE
Last Name:WAISANEN
Suffix:
Gender:M
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 SENDERO DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6316
Mailing Address - Country:US
Mailing Address - Phone:512-413-4497
Mailing Address - Fax:
Practice Address - Street 1:3625 MANCHACA RD
Practice Address - Street 2:SUITE 303
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6631
Practice Address - Country:US
Practice Address - Phone:512-413-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69304101YP2500X
TX202091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist