Provider Demographics
NPI:1881032522
Name:BEHAVIORAL MEDICINE ASSOCIATION OF AUSTIN, PLLC
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATION OF AUSTIN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-968-1900
Mailing Address - Street 1:4613 BEE CAVE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5206
Mailing Address - Country:US
Mailing Address - Phone:512-732-2400
Mailing Address - Fax:
Practice Address - Street 1:231 W LOCKWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2951
Practice Address - Country:US
Practice Address - Phone:314-968-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN54402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty