Provider Demographics
NPI:1083498687
Name:MEYSTEDT, ELLEN MARIE (MA, NCC, LPC-A)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:MEYSTEDT
Suffix:
Gender:F
Credentials:MA, NCC, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7451 PUSCH RIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2461
Mailing Address - Country:US
Mailing Address - Phone:217-370-4106
Mailing Address - Fax:
Practice Address - Street 1:1101 S CAPITAL OF TEXAS HWY BLDG A
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6445
Practice Address - Country:US
Practice Address - Phone:512-522-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional