Provider Demographics
NPI:1831660364
Name:HOOTMAN, NEISHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NEISHA
Middle Name:
Last Name:HOOTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 MEADOWFIRE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3318
Mailing Address - Country:US
Mailing Address - Phone:512-415-6647
Mailing Address - Fax:
Practice Address - Street 1:5555 N LAMAR BLVD STE E125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1052
Practice Address - Country:US
Practice Address - Phone:512-992-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31133103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist