Provider Demographics
NPI:1376828608
Name:BLOCK, BETH (MFT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:BLDG. B, SUITE 400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8666
Mailing Address - Country:US
Mailing Address - Phone:512-217-3523
Mailing Address - Fax:
Practice Address - Street 1:4005 SPICEWOOD SPRINGS RD
Practice Address - Street 2:BLDG. B, SUITE 400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8666
Practice Address - Country:US
Practice Address - Phone:512-217-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist