Provider Demographics
NPI:1942710165
Name:SPACHT, MARK CRAWFORD (LCDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CRAWFORD
Last Name:SPACHT
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 HONEY DEW TER
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1254
Mailing Address - Country:US
Mailing Address - Phone:512-981-9328
Mailing Address - Fax:
Practice Address - Street 1:812 W 11TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2053
Practice Address - Country:US
Practice Address - Phone:512-477-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty