Provider Demographics
NPI:1962115501
Name:WILLIAMSBURG THERAPY GROUP AUSTIN PLLC
Entity type:Organization
Organization Name:WILLIAMSBURG THERAPY GROUP AUSTIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:718-757-7033
Mailing Address - Street 1:2121 S LAMAR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4948
Mailing Address - Country:US
Mailing Address - Phone:718-757-7033
Mailing Address - Fax:
Practice Address - Street 1:2121 S LAMAR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4948
Practice Address - Country:US
Practice Address - Phone:718-757-7033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty