Provider Demographics
NPI:1194964569
Name:DEVELOPMENTAL COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:DEVELOPMENTAL COUNSELING CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:512-383-1036
Mailing Address - Street 1:PO BOX 40476
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0008
Mailing Address - Country:US
Mailing Address - Phone:512-383-1036
Mailing Address - Fax:512-383-1044
Practice Address - Street 1:4403 MANCHACA RD
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1680
Practice Address - Country:US
Practice Address - Phone:512-383-1036
Practice Address - Fax:512-383-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2253A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167953201Medicaid