Provider Demographics
NPI:1821850751
Name:BHATTACHARYYA, MOHADEV (LPC)
Entity Type:Individual
Prefix:
First Name:MOHADEV
Middle Name:
Last Name:BHATTACHARYYA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 MATADOR DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-7061
Mailing Address - Country:US
Mailing Address - Phone:979-402-2017
Mailing Address - Fax:
Practice Address - Street 1:4422 PACK SADDLE PASS STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1644
Practice Address - Country:US
Practice Address - Phone:512-566-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health