Provider Demographics
NPI:1750029765
Name:BLUESTONE PSYCHOLOGY CENTER, LLC
Entity Type:Organization
Organization Name:BLUESTONE PSYCHOLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-809-8379
Mailing Address - Street 1:PO BOX 5603
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78763-5603
Mailing Address - Country:US
Mailing Address - Phone:512-809-8378
Mailing Address - Fax:
Practice Address - Street 1:4613A BEE CAVES RD STE 24
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5212
Practice Address - Country:US
Practice Address - Phone:540-418-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043720048OtherNPI