Provider Demographics
NPI:1568075059
Name:AUSTIN RELATIONSHIP REPAIR SHOP
Entity Type:Organization
Organization Name:AUSTIN RELATIONSHIP REPAIR SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-330-1757
Mailing Address - Street 1:1101 S CAPITAL OF TEXAS HWY STE A200
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6453
Mailing Address - Country:US
Mailing Address - Phone:512-330-1757
Mailing Address - Fax:
Practice Address - Street 1:1101 S CAPITAL OF TEXAS HWY STE A200
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6453
Practice Address - Country:US
Practice Address - Phone:512-330-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty