1629444716 NPI number — MR. RUSSELL KAUITZSCH MS, LPC

Table of content: MR. RUSSELL KAUITZSCH MS, LPC (NPI 1629444716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629444716 NPI number — MR. RUSSELL KAUITZSCH MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUITZSCH
Provider First Name:
RUSSELL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
M

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:
1629444716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 POLAR LN STE 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78613-3073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-731-1395
Provider Business Mailing Address Fax Number:
512-919-4149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 POLAR LN STE 501
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-3073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-731-1395
Provider Business Practice Location Address Fax Number:
512-919-4149
Provider Enumeration Date:
08/12/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  70432 , 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)