Provider Demographics
NPI:1679863450
Name:AUSTIN TRAVIS COUNTY INTEGRAL CARE
Entity type:Organization
Organization Name:AUSTIN TRAVIS COUNTY INTEGRAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRUG COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KITCHING
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:512-769-8789
Mailing Address - Street 1:4019 MANCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6737
Mailing Address - Country:US
Mailing Address - Phone:512-804-3414
Mailing Address - Fax:512-447-2213
Practice Address - Street 1:4019 MANCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6737
Practice Address - Country:US
Practice Address - Phone:512-804-3414
Practice Address - Fax:512-447-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health