Provider Demographics
NPI:1750584835
Name:WILLIAM R. STERN, PH.D.
Entity type:Organization
Organization Name:WILLIAM R. STERN, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-671-4400
Mailing Address - Street 1:15808 RANCH ROAD 620 N
Mailing Address - Street 2:SUITE 212
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4922
Mailing Address - Country:US
Mailing Address - Phone:512-671-4400
Mailing Address - Fax:512-671-4427
Practice Address - Street 1:15808 RANCH ROAD 620 N
Practice Address - Street 2:SUITE 212
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4922
Practice Address - Country:US
Practice Address - Phone:512-671-4400
Practice Address - Fax:512-671-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82800PMedicare ID - Type Unspecified
TX82799PMedicare ID - Type Unspecified