Provider Demographics
NPI:1487181194
Name:TEEN THERAPY AUSTIN
Entity Type:Organization
Organization Name:TEEN THERAPY AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NITYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-402-2650
Mailing Address - Street 1:1301 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:C130
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6574
Mailing Address - Country:US
Mailing Address - Phone:512-402-2650
Mailing Address - Fax:
Practice Address - Street 1:1301 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:C130
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6574
Practice Address - Country:US
Practice Address - Phone:512-402-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty