Provider Demographics
NPI:1689196651
Name:GLASSHOUSE EFFECT PSYCHOTHERAPY CENTER, PLLC
Entity Type:Organization
Organization Name:GLASSHOUSE EFFECT PSYCHOTHERAPY CENTER, PLLC
Other - Org Name:GLASSHOUSE EFFECT PSYCHOTHERAPY CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BOLUTIFE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSUMU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-705-1900
Mailing Address - Street 1:214 ADAM CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4467
Mailing Address - Country:US
Mailing Address - Phone:817-705-1900
Mailing Address - Fax:
Practice Address - Street 1:706 W BEN WHITE BLVD BLDG B
Practice Address - Street 2:STE 184
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:817-789-9744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty