Provider Demographics
NPI:1538563226
Name:GUPTA, ANUSREE (MED LPC)
Entity type:Individual
Prefix:MRS
First Name:ANUSREE
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:MRS
Other - First Name:ANU
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED LPC
Mailing Address - Street 1:16109 DOUBLE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3815
Mailing Address - Country:US
Mailing Address - Phone:512-887-8033
Mailing Address - Fax:
Practice Address - Street 1:111 W ANDERSON LN
Practice Address - Street 2:D197
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1132
Practice Address - Country:US
Practice Address - Phone:512-887-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health