Provider Demographics
NPI:1689082224
Name:PSYCHOLOGICAL ARTS
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-343-8307
Mailing Address - Street 1:7801 N LAMAR BLVD
Mailing Address - Street 2:STE. B169
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1016
Mailing Address - Country:US
Mailing Address - Phone:512-343-8307
Mailing Address - Fax:512-524-2230
Practice Address - Street 1:7801 N LAMAR BLVD
Practice Address - Street 2:STE. B169
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1016
Practice Address - Country:US
Practice Address - Phone:512-343-8307
Practice Address - Fax:512-524-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty