Provider Demographics
NPI:1467237842
Name:BEACON BEHAVIORAL GTX LLC
Entity Type:Organization
Organization Name:BEACON BEHAVIORAL GTX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPP-WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:737-242-0034
Mailing Address - Street 1:4810 SPICEWOOD SPRINGS RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7845
Mailing Address - Country:US
Mailing Address - Phone:512-593-7066
Mailing Address - Fax:512-593-7066
Practice Address - Street 1:712 S AUSTIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5709
Practice Address - Country:US
Practice Address - Phone:737-242-0034
Practice Address - Fax:512-686-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty