| Vida Clinic Pllc | |
|
1221 W Ben White Blvd Ste 210a Austin TX 78704-7182 | |
| (512) 960-4533 | |
| (512) 887-3970 |
| Full Name | Vida Clinic Pllc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1221 W Ben White Blvd Ste 210a, Austin, Texas |
| Authorized Official Name and Position | Alain Stordahl (BUSINESS MANAGER) |
| Authorized Official Contact | 5125377976 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vida Clinic Pllc 1221 W Ben White Blvd Ste 210a Austin TX 78704-7182 Ph: (512) 960-4533 | Vida Clinic Pllc 1221 W Ben White Blvd Ste 210a Austin TX 78704-7182 Ph: (512) 960-4533 |
| NPI Number | 1912389081 |
|---|---|
| Provider Enumeration Date | 06/24/2015 |
| Last Update Date | 08/16/2021 |
| Certification Date | 08/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912389081 | NPI | - | NPPES |
| 3572935-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 34166 (Texas) | Primary |
| 251S00000X | Community/behavioral Health | 34166 (Texas) | Secondary |
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