Provider Demographics
NPI:1386119972
Name:DR. JILLIAN RACINE PLLC
Entity type:Organization
Organization Name:DR. JILLIAN RACINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-346-2332
Mailing Address - Street 1:8140 N MOPAC EXPY STE 3-225
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8862
Mailing Address - Country:US
Mailing Address - Phone:512-346-2332
Mailing Address - Fax:512-346-2284
Practice Address - Street 1:8140 N MOPAC EXPY STE 3-225
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8862
Practice Address - Country:US
Practice Address - Phone:512-346-2332
Practice Address - Fax:512-346-2284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. JILLIAN RACINE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)