Provider Demographics
NPI:1174898910
Name:EYE OF THE HEART, PA
Entity type:Organization
Organization Name:EYE OF THE HEART, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-297-8717
Mailing Address - Street 1:4403 MANCHACA RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1680
Mailing Address - Country:US
Mailing Address - Phone:512-297-8717
Mailing Address - Fax:888-395-2986
Practice Address - Street 1:4403 MANCHACA RD
Practice Address - Street 2:SUITE D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1680
Practice Address - Country:US
Practice Address - Phone:512-297-8717
Practice Address - Fax:888-395-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty