# CENTRAL PINES PSYCHOLOGICAL ASSOCIATES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811189806
- **Authorized official:** JAN ULRIK MICHELL MBA (BILLING MANAGER)
- **Authorized official phone:** (210) 473-4729

## Contact information

- **Practice address:** 1011 ALLEY A ST, BASTROP, TX 78602-3240
- **Practice address phone:** (512) 529-1538
- **Practice address fax:** (210) 579-6582
- **Mailing address:** PO BOX 1003, BASTROP, TX 78602-1003
- **Mailing address phone:** (512) 529-1538
- **Mailing address fax:** (210) 579-6582

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 33431 | TX | Yes |

## Other

- **Enumeration date:** 08/14/2007
- **Last updated:** 06/13/2008