Provider Demographics
NPI:1679785844
Name:LINDA A MAC NEILAGE PHD PC
Entity Type:Organization
Organization Name:LINDA A MAC NEILAGE PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAC NEILAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-478-7069
Mailing Address - Street 1:606 HARTHAN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5216
Mailing Address - Country:US
Mailing Address - Phone:512-478-7069
Mailing Address - Fax:
Practice Address - Street 1:606 HARTHAN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5216
Practice Address - Country:US
Practice Address - Phone:512-478-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty