Provider Demographics
NPI:1467830703
Name:ANXIETY TREATMENT CENTER OF AUSTIN, PLLD
Entity type:Organization
Organization Name:ANXIETY TREATMENT CENTER OF AUSTIN, PLLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DAMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-879-1836
Mailing Address - Street 1:8701 SHOAL CREEK BLVD
Mailing Address - Street 2:404
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6864
Mailing Address - Country:US
Mailing Address - Phone:512-879-1836
Mailing Address - Fax:512-371-7145
Practice Address - Street 1:8701 SHOAL CREEK BLVD
Practice Address - Street 2:404
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6864
Practice Address - Country:US
Practice Address - Phone:512-879-1836
Practice Address - Fax:512-371-7145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty