Provider Demographics
NPI:1750558359
Name:HYDE PARK COUNSELING CENTER
Entity type:Organization
Organization Name:HYDE PARK COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DANYON
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-451-2186
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-451-2186
Mailing Address - Fax:512-451-1950
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:SUITE E-2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-451-2186
Practice Address - Fax:512-451-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33075103T00000X
TX33153103T00000X
TX32308103TS0200X
TX11813101YP2500X
TX32587103TS0200X
TX16033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty