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Organization
CENTRAL PINES PSYCHOLOGICAL ASSOCIATES PLLC
Active
Organization
CENTRAL PINES PSYCHOLOGICAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN ULRIK MICHELL MBA (BILLING MANAGER)
(210) 473-4729
Entity
Organization
Contact information
Practice address
1011 ALLEY A ST, BASTROP, TX 78602-3240
(512) 529-1538
(210) 579-6582
Mailing address
PO BOX 1003, BASTROP, TX 78602-1003
(512) 529-1538
(210) 579-6582
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
33431
TX
Other
Enumeration date
08/14/2007
Last updated
06/13/2008
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