VIDA CLINIC PLLC (NPI# 1912389081) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912389081 |
| Entity Type | Organization |
| Organization Name | VIDA CLINIC PLLC |
| Practice Address |
5601 Manchaca Rd Austin TX 78745 |
| Mailing Address |
1221 W Ben White Blvd Ste 210a Austin TX 78704-7182 |
| Practice Telephone | 5129604533 |
| Practice Fax Number | 5128873970 |
| Mailing Telephone | 5129604533 |
| Mailing Fax Number | 5128873970 |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2018-06-04 |
| Authorized Official Name | WANDA NAZARIO (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 5129604533 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | 34166 | TX | Agencies |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
34166 | TX | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 3572935-01 | 05 |
| Street Address |
5601 MANCHACA RD |
| City | AUSTIN |
| State | TX |
| Zip Code | 78745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285959015 | Elizabeth Minne | Psychologist | 5601 Manchaca Rd, Austin, TX 78745 | 2010-04-05 |
| 1831656867 | Samantha A Borrego Maccallon | Counselor | 5601 Manchaca Rd, Austin, TX 78745-3633 | 2019-02-26 |
| 1174016224 | Christine Hanlon | Social Worker | 5601 Manchaca Rd, Austin, TX 78745-3633 | 2018-06-13 |
| 1396238341 | Leslie Erwin | Social Worker | 5601 Manchaca Rd, Austin, TX 78745-3633 | 2018-06-13 |
| 1497248538 | Mandy Stalcup | Social Worker | 5601 Manchaca Rd, Austin, TX 78745-3633 | 2018-06-13 |
| 1558854778 | Maribel Montiel | Social Worker | 5601 Manchaca Rd, Austin, TX 78745-3633 | 2018-06-12 |
| 1619460821 | Christina Hurtado | Social Worker | 5601 Manchaca Rd, Austin, TX 78745-3633 | 2018-06-12 |
| 1710470919 | Anne Wiik | Social Worker | 5601 Manchaca Rd, Austin, TX 78745-3633 | 2018-06-12 |
| 1427540426 | Alexandra Rudy | Counselor | 5601 Manchaca Rd, Austin, TX 78745 | 2018-06-05 |
| 1255702510 | Sarah Wyatt | Social Worker | 5601 Manchaca Rd, Austin, TX 78745 | 2015-10-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023617511 | Samantha Lynne Weston | Speech-Language Pathologist | 8515 Brodie Lane, Apt 2011, Austin, TX 78745 | 2020-10-26 |
| 1275172686 | Nithphaphone Tracy Bounsing | Registered Nurse | 4316 James Casey St, Building F, Suite 201, Austin, TX 78745 | 2020-01-02 |
| 1225685712 | Integrative Medical Group of Texas | General Practice | 6905 West Gate Blvd. Ste A, Austin, TX 78745 | 2019-08-20 |
| 1962971499 | Kimberly Angela Mancini | Social Worker | 5015 South Ih 35 Frontage Road, Austin, TX 78745 | 2018-11-14 |
| 1093223885 | Emma Rose Marek | Speech-Language Pathologist | 2700 Norfolk Drive, Austin, TX 78745 | 2018-01-16 |
| 1528586690 | Ashley Ellison | Social Worker | 4201 South Congress, Austin, TX 78745 | 2017-09-08 |
| 1134666761 | Carey Sebera | Counselor | 2812 Goldbridge Dr, Austin, TX 78745 | 2017-01-20 |
| 1932644507 | Maya Conlon | Social Worker | 2501 W. William Cannon Dr., Bldg 6 Ste. A, Austin, TX 78745 | 2017-01-05 |
| 1285189134 | 512 Physical Therapy and Golf Performance Center | Physical Therapist | 6800 Westgate Blvd, Suite 117, Austin, TX 78745 | 2016-08-22 |
| 1326401803 | Chris Winkley | Physical Therapist | 5510 S Ih 35 Frontage Rd #240, Austin, TX 78745 | 2016-04-01 |
| Find all providers in zip 78745 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184241598 | Mellissa Tong | Psychologist | 113 W 33rd St, Austin, TX 78705-2313 | 2020-07-01 |
| 1235754201 | Amanda Max Hilberg | Psychologist | 5900 Balcones Dr Ste 190, Austin, TX 78731-4295 | 2020-06-15 |
| 1427682871 | Charnel Hollier | Psychologist | 1500 W 38th St Ste 31, Austin, TX 78731-6318 | 2020-02-25 |
| 1053950329 | Erin G Underbrink Newins | Psychologist | 2100 Pipers Field Dr Apt 36, Austin, TX 78758-2548 | 2020-01-03 |
| 1629553953 | Pulverman Psychological Services, Pllc | Psychologist | 3160 Bee Caves Rd Ste 300, Austin, TX 78746-5591 | 2018-10-02 |
| 1770079071 | Donna Carpenter | Psychologist | 3724 Jefferson St Ste 200, Austin, TX 78731-6221 | 2018-07-10 |
| 1942790068 | Julia Jeannette Zenteno-montez | Psychologist | 7901 Metropolis Dr # 11a-2, Austin, TX 78744-3111 | 2018-05-14 |
| 1558861583 | Dr. Jillian Racine | Psychologist | 8140 N Mopac Expy Ste 3-225, Austin, TX 78759-8862 | 2018-02-16 |
| 1063921708 | Mariel Smith Cannady | Psychologist | 4407 Pack Saddle Pass, Austin, TX 78745-1623 | 2017-09-26 |
| 1386161750 | Jessica A Peller | Psychologist | 9701 Brodie Ln Ste 205, Austin, TX 78748-6284 | 2017-08-27 |
| Find all providers in AUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.