Provider Demographics
NPI:1427693928
Name:THE UNIVERSITY OF TEXAS AT AUSTIN
Entity type:Organization
Organization Name:THE UNIVERSITY OF TEXAS AT AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR, BUSINESS SERVIC
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHUSLAV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-232-1736
Mailing Address - Street 1:100 W DEAN KEETON ST.
Mailing Address - Street 2:SUITE 2.106
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:512-471-0680
Practice Address - Street 1:100 W DEAN KEETON ST.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712
Practice Address - Country:US
Practice Address - Phone:512-471-3515
Practice Address - Fax:512-471-0680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF TEXAS AT AUSTIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty