Provider Demographics
NPI:1639568991
Name:VIBRANT MINDS, PLLC
Entity Type:Organization
Organization Name:VIBRANT MINDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEROUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-944-5856
Mailing Address - Street 1:10711 BURNET RD
Mailing Address - Street 2:SUITE 321
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10711 BURNET RD
Practice Address - Street 2:SUITE 321
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4478
Practice Address - Country:US
Practice Address - Phone:512-944-5856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty