Provider Demographics
NPI:1679210686
Name:COUNSELING FOR ATHLETES PLLC
Entity Type:Organization
Organization Name:COUNSELING FOR ATHLETES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KEOGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-617-0706
Mailing Address - Street 1:PO BOX 143942
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78714-3942
Mailing Address - Country:US
Mailing Address - Phone:830-708-0501
Mailing Address - Fax:
Practice Address - Street 1:2520 LONGVIEW ST STE 212
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4201
Practice Address - Country:US
Practice Address - Phone:512-176-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty