| Four Falls Cedar Park Pllc | |
|
2006 S Bagdad Rd Ste 130 Leander TX 78641-3577 | |
| (512) 253-1465 | |
| (855) 310-6497 |
| Full Name | Four Falls Cedar Park Pllc |
|---|---|
| Speciality | Counselor |
| Location | 2006 S Bagdad Rd Ste 130, Leander, Texas |
| Authorized Official Name and Position | Kindra Michelle Gonzalez (OWNER) |
| Authorized Official Contact | 5127301049 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Falls Cedar Park Pllc 8632 White Ibis Dr Austin TX 78729-8095 Ph: (512) 751-1811 | Four Falls Cedar Park Pllc 2006 S Bagdad Rd Ste 130 Leander TX 78641-3577 Ph: (512) 253-1465 |
| NPI Number | 1548966864 |
|---|---|
| Provider Enumeration Date | 02/07/2023 |
| Last Update Date | 05/06/2025 |
| Certification Date | 05/06/2025 |
| Medicare PECOS PAC ID | 5799122727 |
|---|---|
| Medicare Enrollment ID | O20240326001299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548966864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kindra Michelle Gonzalez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326658055 PECOS PAC ID: 5597102525 Enrollment ID: I20240326001917 |
| Provider Name | Jennifer Rose Hodges |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225554942 PECOS PAC ID: 4587001540 Enrollment ID: I20240326002505 |
| Provider Name | Supritha Sampath |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669074860 PECOS PAC ID: 5799229258 Enrollment ID: I20240626001473 |
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