Provider Demographics
NPI:1417415514
Name:EMDR THERAPY AUSTIN PLLC
Entity Type:Organization
Organization Name:EMDR THERAPY AUSTIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLWOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-900-7913
Mailing Address - Street 1:2111 DICKSON DR STE 33
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4788
Mailing Address - Country:US
Mailing Address - Phone:512-900-7913
Mailing Address - Fax:
Practice Address - Street 1:2111 DICKSON DR STE 33
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4788
Practice Address - Country:US
Practice Address - Phone:512-900-7913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty