Provider Demographics
NPI:1477220085
Name:EMERGE RECOVERY TX, LLC
Entity Type:Organization
Organization Name:EMERGE RECOVERY TX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LCDC-I
Authorized Official - Phone:832-477-4325
Mailing Address - Street 1:7756 NORTHCROSS DR STE 203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1725
Mailing Address - Country:US
Mailing Address - Phone:737-237-9663
Mailing Address - Fax:833-318-0324
Practice Address - Street 1:7756 NORTHCROSS DR STE 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1725
Practice Address - Country:US
Practice Address - Phone:737-237-9663
Practice Address - Fax:833-318-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNAOtherN/A