Provider Demographics
NPI:1629960463
Name:AXIS OF MENTAL HEALTHCARE, PLLC
Entity type:Organization
Organization Name:AXIS OF MENTAL HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S, LMFT
Authorized Official - Phone:512-222-8759
Mailing Address - Street 1:14205 N MO PAC EXPY STE 570
Mailing Address - Street 2:PMB 402404
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6529
Mailing Address - Country:US
Mailing Address - Phone:512-222-8759
Mailing Address - Fax:
Practice Address - Street 1:361 N POST OAK LN APT 243
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-5949
Practice Address - Country:US
Practice Address - Phone:713-398-4642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health