Provider Demographics
NPI:1568677284
Name:TEXAS COLLEGE OF TRADITIONAL CHINESE MEDICINE
Entity Type:Organization
Organization Name:TEXAS COLLEGE OF TRADITIONAL CHINESE MEDICINE
Other - Org Name:TEXAS COLLEGE OF TCM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:512-445-4444
Mailing Address - Street 1:1707 FORT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7620
Mailing Address - Country:US
Mailing Address - Phone:512-445-4444
Mailing Address - Fax:512-707-8866
Practice Address - Street 1:1707 FORT VIEW RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7620
Practice Address - Country:US
Practice Address - Phone:512-445-4444
Practice Address - Fax:512-707-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty