Provider Demographics
NPI:1790143030
Name:AUSTIN PSYCHOTHERAPY & TRAINING CENTER
Entity Type:Organization
Organization Name:AUSTIN PSYCHOTHERAPY & TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:281-433-4649
Mailing Address - Street 1:3907 BRADEN DR N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-6796
Mailing Address - Country:US
Mailing Address - Phone:281-433-4649
Mailing Address - Fax:
Practice Address - Street 1:12234 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE 1108
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7330
Practice Address - Country:US
Practice Address - Phone:281-433-4649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15135251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053501098OtherNPI