Provider Demographics
NPI:1558479063
Name:HAVLICK, NATHAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:HAVLICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:HAVLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 82113
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78708-2113
Mailing Address - Country:US
Mailing Address - Phone:512-464-1146
Mailing Address - Fax:
Practice Address - Street 1:2306 LAKE AUSTIN BLVD # 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4546
Practice Address - Country:US
Practice Address - Phone:512-464-1146
Practice Address - Fax:512-464-1146
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical