Provider Demographics
NPI:1902560725
Name:VENKATESAN, SAMBAVI
Entity Type:Individual
Prefix:
First Name:SAMBAVI
Middle Name:
Last Name:VENKATESAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 N PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3601
Mailing Address - Country:US
Mailing Address - Phone:512-735-2100
Mailing Address - Fax:
Practice Address - Street 1:835 N PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3601
Practice Address - Country:US
Practice Address - Phone:512-735-2100
Practice Address - Fax:512-735-2452
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional