Provider Demographics
NPI:1548966864
Name:FOUR FALLS CEDAR PARK PLLC
Entity type:Organization
Organization Name:FOUR FALLS CEDAR PARK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KINDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-730-1049
Mailing Address - Street 1:8632 WHITE IBIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-8095
Mailing Address - Country:US
Mailing Address - Phone:512-751-1811
Mailing Address - Fax:
Practice Address - Street 1:2006 S BAGDAD RD STE 130
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3577
Practice Address - Country:US
Practice Address - Phone:512-253-1465
Practice Address - Fax:855-310-6497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty