| Central Pines Psychological Associates Pllc | |
|
1011 Alley A St Bastrop TX 78602-3240 | |
| (512) 529-1538 | |
| (210) 579-6582 |
| Full Name | Central Pines Psychological Associates Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 1011 Alley A St, Bastrop, Texas |
| Authorized Official Name and Position | Jan Ulrik Michell (BILLING MANAGER) |
| Authorized Official Contact | 2104734729 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Pines Psychological Associates Pllc Po Box 1003 Bastrop TX 78602-1003 Ph: (512) 529-1538 | Central Pines Psychological Associates Pllc 1011 Alley A St Bastrop TX 78602-3240 Ph: (512) 529-1538 |
| NPI Number | 1811189806 |
|---|---|
| Provider Enumeration Date | 08/14/2007 |
| Last Update Date | 06/13/2008 |
| Medicare PECOS PAC ID | 8729162318 |
|---|---|
| Medicare Enrollment ID | O20080220000530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811189806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 33431 (Texas) | Primary |
| Provider Name | Stacy L Rider |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487863130 PECOS PAC ID: 7719061308 Enrollment ID: I20240509003511 |
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