1194040709 NPI number — MISCHCA T. SCALES, PHD, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194040709 NPI number — MISCHCA T. SCALES, PHD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISCHCA T. SCALES, PHD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194040709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7417 TURNBUOY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78730-4333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-507-6342
Provider Business Mailing Address Fax Number:
512-531-9271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N HASLER BLVD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-507-6342
Provider Business Practice Location Address Fax Number:
512-531-9271
Provider Enumeration Date:
04/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCALES
Authorized Official First Name:
MISCHCA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
512-507-6342

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  31559 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 161254101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86843A . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 600663363 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com