Provider Demographics
NPI:1821695610
Name:MY-EMERGE,PLLC
Entity Type:Organization
Organization Name:MY-EMERGE,PLLC
Other - Org Name:MY-EMERGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-400-2575
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-1141
Mailing Address - Country:US
Mailing Address - Phone:512-861-4154
Mailing Address - Fax:737-787-3714
Practice Address - Street 1:12343 HYMEADOW DR STE 3E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1858
Practice Address - Country:US
Practice Address - Phone:512-861-4154
Practice Address - Fax:737-787-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427579309Other705009