Provider Demographics
NPI:1366552580
Name:SOUTHWEST BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:SOUTHWEST BEHAVIORAL HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC BMC
Authorized Official - Phone:512-899-8217
Mailing Address - Street 1:3420 TRAVIS COUNTRY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735
Mailing Address - Country:US
Mailing Address - Phone:812-899-8217
Mailing Address - Fax:512-899-2704
Practice Address - Street 1:4310 JAMES CASEY, BLDG 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-899-8217
Practice Address - Fax:512-899-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX18179103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty