Provider Demographics
NPI:1609551860
Name:CHALICE PSYCHOTHERAPIES, PLLC
Entity Type:Organization
Organization Name:CHALICE PSYCHOTHERAPIES, PLLC
Other - Org Name:RESOLVE ETT LIGHT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:737-471-9697
Mailing Address - Street 1:5310 JOE SAYERS AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2141
Mailing Address - Country:US
Mailing Address - Phone:512-636-1333
Mailing Address - Fax:
Practice Address - Street 1:9501 N CAPITAL OF TEXAS HWY STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7254
Practice Address - Country:US
Practice Address - Phone:737-471-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)