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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