Provider Demographics
NPI:1346490562
Name:AUSTIN WELLNESS, PLLC
Entity Type:Organization
Organization Name:AUSTIN WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC, LPC
Authorized Official - Phone:512-257-0050
Mailing Address - Street 1:10010 ANDERSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2127
Mailing Address - Country:US
Mailing Address - Phone:512-257-0050
Mailing Address - Fax:512-257-0050
Practice Address - Street 1:10010 ANDERSON MILL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2127
Practice Address - Country:US
Practice Address - Phone:512-257-0050
Practice Address - Fax:512-257-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty