1023325032 NPI number — ZEGEMA PROFESSIONAL RESOURCE CENTER

Table of content: EMILY LOUISE HALLER LPCA (NPI 1013401579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023325032 NPI number — ZEGEMA PROFESSIONAL RESOURCE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZEGEMA PROFESSIONAL RESOURCE CENTER
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:
6
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:
1023325032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1825 FORT VW
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-7657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-541-2133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825 FORT VW
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-541-2133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HUBER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
512-541-2133

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  30636 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 34416 , 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)





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