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2021 Guadalupe St Ste 260 Austin TX 78705-5654 | |
| (720) 515-4244 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 2021 Guadalupe St Ste 260, Austin, Texas |
| Authorized Official Name and Position | Janean Anderson (OWNER) |
| Authorized Official Contact | 7205154244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1777 S Bellaire St Ste 390 Denver CO 80222-4350 Ph: (720) 515-4244 | 2021 Guadalupe St Ste 260 Austin TX 78705-5654 Ph: (720) 515-4244 |
| NPI Number | 1356109417 |
|---|---|
| Provider Enumeration Date | 03/12/2024 |
| Last Update Date | 07/22/2024 |
| Certification Date | 07/22/2024 |
| Medicare PECOS PAC ID | 8527335835 |
|---|---|
| Medicare Enrollment ID | O20240822000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356109417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Katarzyna Kundera Byrd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366094187 PECOS PAC ID: 1153758982 Enrollment ID: I20240822001671 |
| Provider Name | Janice Anne Moran |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588183966 PECOS PAC ID: 7618408378 Enrollment ID: I20241004001888 |
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