Provider Demographics
NPI:1245079078
Name:WARTENBERG-CHIANG, OLGA (PSYD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:WARTENBERG-CHIANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:WARTENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-0730
Mailing Address - Country:US
Mailing Address - Phone:720-940-3089
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 8044
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:720-940-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40141103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy