| Polaris Therapy, Llc | |
|
1704 W Koenig Ln Austin TX 78756-1207 | |
| (307) 287-2639 | |
| Not Available |
| Full Name | Polaris Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1704 W Koenig Ln, Austin, Texas |
| Authorized Official Name and Position | Andrew Davis (THERAPIST) |
| Authorized Official Contact | 3072872639 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Polaris Therapy, Llc 161 Light Timber Rd Maxwell TX 78656-4405 Ph: (307) 287-2639 | Polaris Therapy, Llc 1704 W Koenig Ln Austin TX 78756-1207 Ph: (307) 287-2639 |
| NPI Number | 1386417210 |
|---|---|
| Provider Enumeration Date | 11/02/2023 |
| Last Update Date | 11/02/2023 |
| Certification Date | 11/02/2023 |
| Medicare PECOS PAC ID | 6305296146 |
|---|---|
| Medicare Enrollment ID | O20231220001533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386417210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Andrew Michael Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417421009 PECOS PAC ID: 0941618383 Enrollment ID: I20210423000065 |
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