| Honored Soul Psychotherapy Center, Llc | |
|
10308 Anahuac Trl Austin TX 78747-2704 | |
| (847) 687-8774 | |
| Not Available |
| Full Name | Honored Soul Psychotherapy Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 10308 Anahuac Trl, Austin, Texas |
| Authorized Official Name and Position | Dominique Agypt (OWNER) |
| Authorized Official Contact | 8476878774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Honored Soul Psychotherapy Center, Llc 9901 Brodie Ln Ste. 160 Pmb 1189 Austin TX 78748-5892 Ph: (847) 687-8774 | Honored Soul Psychotherapy Center, Llc 10308 Anahuac Trl Austin TX 78747-2704 Ph: (847) 687-8774 |
| NPI Number | 1467172775 |
|---|---|
| Provider Enumeration Date | 08/29/2022 |
| Last Update Date | 08/29/2022 |
| Certification Date | 08/29/2022 |
| Medicare PECOS PAC ID | 0941743074 |
|---|---|
| Medicare Enrollment ID | O20240618001466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467172775 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Dominique M Agypt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780108050 PECOS PAC ID: 8022420033 Enrollment ID: I20231212002456 |
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