1649835216 NPI number — KALEIDOSCOPE COUNSELING AND ASSESSMENT

Table of content: (NPI 1649835216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649835216 NPI number — KALEIDOSCOPE COUNSELING AND ASSESSMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALEIDOSCOPE COUNSELING AND ASSESSMENT
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:
1649835216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1705 S CAPITAL OF TEXAS HWY STE 130
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:
78746-6587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-981-8787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 S CAPITAL OF TEXAS HWY STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-6587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-981-8787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
512-981-8787

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1003341025 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932346889 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467750406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609251339 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871700583 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".