Provider Demographics
NPI:1679691174
Name:VIATOR, MARK LEWIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LEWIS
Last Name:VIATOR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 GREENHEART DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2283
Mailing Address - Country:US
Mailing Address - Phone:512-443-0617
Mailing Address - Fax:
Practice Address - Street 1:3215 STECK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7566
Practice Address - Country:US
Practice Address - Phone:512-452-2929
Practice Address - Fax:512-452-5656
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical