Provider Demographics
NPI:1629498993
Name:AUSTIN RESTORATIVE THERAPIES
Entity Type:Organization
Organization Name:AUSTIN RESTORATIVE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TREADWAY-TERAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:512-430-0540
Mailing Address - Street 1:6448 E HIGHWAY 290
Mailing Address - Street 2:BUILDING E # 114
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1068
Mailing Address - Country:US
Mailing Address - Phone:512-430-0540
Mailing Address - Fax:866-788-3579
Practice Address - Street 1:6448 E HIGHWAY 290
Practice Address - Street 2:BUILDING E # 114
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1068
Practice Address - Country:US
Practice Address - Phone:512-430-0540
Practice Address - Fax:866-788-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201227261QM0801X, 261QM0855X
CA40138261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health