Provider Demographics
NPI:1023325032
Name:ZEGEMA PROFESSIONAL RESOURCE CENTER
Entity type:Organization
Organization Name:ZEGEMA PROFESSIONAL RESOURCE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:SR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:512-541-2133
Mailing Address - Street 1:1825 FORT VW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7657
Mailing Address - Country:US
Mailing Address - Phone:512-541-2133
Mailing Address - Fax:
Practice Address - Street 1:1825 FORT VW
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7657
Practice Address - Country:US
Practice Address - Phone:512-541-2133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30636103TS0200X
TX34416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty