Provider Demographics
NPI:1487759189
Name:ESCAMILLA, ANNA (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11673 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3933
Mailing Address - Country:US
Mailing Address - Phone:512-401-0002
Mailing Address - Fax:512-401-0006
Practice Address - Street 1:11673 JOLLYVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3933
Practice Address - Country:US
Practice Address - Phone:512-401-0002
Practice Address - Fax:512-401-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX027971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S69YOtherBLUE CROSS BLUE SHIELD
TX00S69YOtherBLUE CROSS BLUE SHIELD