| Cerridwen Inc | |
|
3021 Mccurdy St Austin TX 78723-2902 | |
| (512) 267-2614 | |
| (512) 267-9637 |
| Full Name | Cerridwen Inc |
|---|---|
| Speciality | Counselor |
| Location | 3021 Mccurdy St, Austin, Texas |
| Authorized Official Name and Position | Diana E Sellers (OWNER) |
| Authorized Official Contact | 5122672614 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cerridwen Inc 901 E 12th St Austin TX 78702-1008 Ph: (512) 267-2614 | Cerridwen Inc 3021 Mccurdy St Austin TX 78723-2902 Ph: (512) 267-2614 |
| NPI Number | 1558514414 |
|---|---|
| Provider Enumeration Date | 10/23/2008 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Medicare PECOS PAC ID | 8628413432 |
|---|---|
| Medicare Enrollment ID | O20240304001020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558514414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP1600X | Counselor - Pastoral | (* (Not Available)) | Primary |
| Provider Name | Diana Sellers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639266208 PECOS PAC ID: 5496847329 Enrollment ID: I20240412001216 |
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