Provider Demographics
NPI:1780260471
Name:OPEN HEART COUNSELING OF AUSTIN PLLC
Entity type:Organization
Organization Name:OPEN HEART COUNSELING OF AUSTIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, RPT-S
Authorized Official - Phone:254-718-8373
Mailing Address - Street 1:13587 MESA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4714
Mailing Address - Country:US
Mailing Address - Phone:254-718-8373
Mailing Address - Fax:
Practice Address - Street 1:8101 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8103
Practice Address - Country:US
Practice Address - Phone:254-718-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730572736OtherNPI TYPE 1