Provider Demographics
NPI:1750493458
Name:IYENGAR, LATHA (LCSW, ACP)
Entity Type:Individual
Prefix:
First Name:LATHA
Middle Name:
Last Name:IYENGAR
Suffix:
Gender:F
Credentials:LCSW, ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 DEL MESA LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6837
Mailing Address - Country:US
Mailing Address - Phone:512-250-1441
Mailing Address - Fax:512-250-2110
Practice Address - Street 1:12885 N HIGHWAY 183
Practice Address - Street 2:SUITE # 209-A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3220
Practice Address - Country:US
Practice Address - Phone:512-250-1441
Practice Address - Fax:512-250-2110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS111441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical