Provider Demographics
NPI:1417573965
Name:AUSTIN TRAUMA THERAPY CENTER
Entity Type:Organization
Organization Name:AUSTIN TRAUMA THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANZALDUA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-270-8215
Mailing Address - Street 1:111 RAMBLE LN STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2281
Mailing Address - Country:US
Mailing Address - Phone:512-270-8215
Mailing Address - Fax:
Practice Address - Street 1:111 RAMBLE LN STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2281
Practice Address - Country:US
Practice Address - Phone:512-270-8215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-21
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health