| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4100 Avenue D, Austin, Texas |
| Authorized Official Name and Position | Charles Jason Earle (DIRECTOR) |
| Authorized Official Contact | 8555532783 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1101 W 34th St Ste 256 Austin TX 78705-1907 Ph: (855) 553-2753 | 4100 Avenue D Austin TX 78751 Ph: (855) 553-2783 |
| NPI Number | 1518330554 |
|---|---|
| Provider Enumeration Date | 11/12/2015 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/10/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518330554 | NPI | - | NPPES |
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