Provider Demographics
NPI:1154525509
Name:AUSTIN CENTER FOR THERAPY AND ASSESSMENT
Entity type:Organization
Organization Name:AUSTIN CENTER FOR THERAPY AND ASSESSMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARON
Authorized Official - Middle Name:X
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-608-1165
Mailing Address - Street 1:8103 BRODIE LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7473
Mailing Address - Country:US
Mailing Address - Phone:512-608-1166
Mailing Address - Fax:512-448-0499
Practice Address - Street 1:8103 BRODIE LN
Practice Address - Street 2:SUITE 1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7473
Practice Address - Country:US
Practice Address - Phone:512-608-1166
Practice Address - Fax:512-448-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19839OtherLPC