Provider Demographics
NPI:1629444716
Name:KAUITZSCH, RUSSELL (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:KAUITZSCH
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 POLAR LN STE 501
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3073
Mailing Address - Country:US
Mailing Address - Phone:512-731-1395
Mailing Address - Fax:512-919-4149
Practice Address - Street 1:3000 POLAR LN STE 501
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3073
Practice Address - Country:US
Practice Address - Phone:512-731-1395
Practice Address - Fax:512-919-4149
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional