Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 23174 | TX |
NPI | 1053490482 |
---|---|
Provider Name | Joan Melinda Offerle |
First Address | Austin, TX 78759-8661 |
Second Address | Austin, TX 78759-8661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2006 |
Last Update Date | 08/07/2007 |