Provider Demographics
NPI:1346411931
Name:DEEPSKY ENTERPRISES, PLLC
Entity Type:Organization
Organization Name:DEEPSKY ENTERPRISES, PLLC
Other - Org Name:NATE HAVLICK, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-464-1146
Mailing Address - Street 1:2306 LAKE AUSTIN BLVD # 203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4546
Mailing Address - Country:US
Mailing Address - Phone:512-464-1146
Mailing Address - Fax:512-464-1146
Practice Address - Street 1:2306 LAKE AUSTIN BLVD # 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4546
Practice Address - Country:US
Practice Address - Phone:512-464-1146
Practice Address - Fax:512-464-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29883261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health