| Live Oak Collective Llc | |
|
2603 Willow St Austin TX 78702-5631 | |
| (512) 765-6657 | |
| Not Available |
| Full Name | Live Oak Collective Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2603 Willow St, Austin, Texas |
| Authorized Official Name and Position | Sarah Elizabeth Kincheloe (CO OWNER) |
| Authorized Official Contact | 5127656657 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Oak Collective Llc 2603 Willow St Austin TX 78702-5631 Ph: (512) 765-6657 | Live Oak Collective Llc 2603 Willow St Austin TX 78702-5631 Ph: (512) 765-6657 |
| NPI Number | 1841944857 |
|---|---|
| Provider Enumeration Date | 02/08/2022 |
| Last Update Date | 02/08/2022 |
| Certification Date | 02/08/2022 |
| Medicare PECOS PAC ID | 9133516404 |
|---|---|
| Medicare Enrollment ID | O20220505000884 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841944857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sarah Elizabeth Kincheloe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134401995 PECOS PAC ID: 8628393139 Enrollment ID: I20150204000584 |
| Provider Name | Chatone F Strickland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285226050 PECOS PAC ID: 1153736137 Enrollment ID: I20210225001572 |
| Provider Name | Sarah Fanucci |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164166245 PECOS PAC ID: 4587039375 Enrollment ID: I20230410000849 |
| Provider Name | Bethany Jordyn Mcwilliams |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1861181109 PECOS PAC ID: 2365892767 Enrollment ID: I20231227002958 |
| Provider Name | Elizabeth Ann Banks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508323288 PECOS PAC ID: 1254781511 Enrollment ID: I20231228002050 |
| Provider Name | Ailyne Juarez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316430960 PECOS PAC ID: 3375993371 Enrollment ID: I20240102004115 |
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