| Ritual Wellness Atx Pllc | |
|
4131 Spicewood Springs Rd Ste I7 Austin TX 78759-8659 | |
| (903) 914-0224 | |
| Not Available |
| Full Name | Ritual Wellness Atx Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 4131 Spicewood Springs Rd Ste I7, Austin, Texas |
| Authorized Official Name and Position | Shannon Leigh Stavinoha (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 9039140224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ritual Wellness Atx Pllc Po Box 170073 Austin TX 78717-0004 Ph: () - | Ritual Wellness Atx Pllc 4131 Spicewood Springs Rd Ste I7 Austin TX 78759-8659 Ph: (903) 914-0224 |
| NPI Number | 1932874633 |
|---|---|
| Provider Enumeration Date | 08/13/2021 |
| Last Update Date | 09/16/2021 |
| Certification Date | 09/16/2021 |
| Medicare PECOS PAC ID | 5597155366 |
|---|---|
| Medicare Enrollment ID | O20211209002535 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932874633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Lauren Mason |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639587991 PECOS PAC ID: 2567852379 Enrollment ID: I20220503000014 |
| Provider Name | Kruti Patel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487118311 PECOS PAC ID: 2860870623 Enrollment ID: I20220607001313 |
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