Individual
DR. FRED IMUENTINYAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
5900 BALCONES DR STE 100, AUSTIN, TX 78731-4298
(817) 676-1908
Mailing address
5900 BALCONES DR STE 100, AUSTIN, TX 78731-4298
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
40056
TX
Other
Enumeration date
11/11/2024
Last updated
01/19/2025
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