Provider Demographics
NPI:1912054776
Name:AUSTIN CHILD GUIDANCE CENTER
Entity Type:Organization
Organization Name:AUSTIN CHILD GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-451-2242
Mailing Address - Street 1:810 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2802
Mailing Address - Country:US
Mailing Address - Phone:512-451-2242
Mailing Address - Fax:512-454-9204
Practice Address - Street 1:810 W 45TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2802
Practice Address - Country:US
Practice Address - Phone:512-451-2242
Practice Address - Fax:512-454-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01043JCOtherBLUE CROSS BLUE SHEILD