Provider Demographics
NPI:1225848138
Name:STATES BECOME TRAITS
Entity type:Organization
Organization Name:STATES BECOME TRAITS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DENNARD
Authorized Official - Last Name:MCINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-318-5929
Mailing Address - Street 1:14416 AMERICAN KESTREL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6520
Mailing Address - Country:US
Mailing Address - Phone:512-318-5929
Mailing Address - Fax:
Practice Address - Street 1:14416 AMERICAN KESTREL DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6520
Practice Address - Country:US
Practice Address - Phone:512-318-5929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty