Central Texas Geriatric Behavioral Health

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

34161 Issued in TX

Legal business name

CENTRAL TEXAS GERIATRIC BEHAVIORAL HEALTH

Practice address

2504 Rae Dell Ave
Austin, TX 78704-4735

Phone

(512) 284-3712

Fax

(855) 700-9866

NPI assigned

Aug 12, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joseph Slade Bosarge, PH.D

Title

Ceo

Phone

(512) 680-3013

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376265600000",
    "number": "1316370562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 RAE DELL AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787044735",
            "telephone_number": "512-284-3712",
            "fax_number": "855-700-9866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 RAE DELL AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787044735",
            "telephone_number": "512-284-3712",
            "fax_number": "855-700-9866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL TEXAS GERIATRIC BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-12",
        "last_updated": "2013-08-12",
        "status": "A",
        "authorized_official_last_name": "BOSARGE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "SLADE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-680-3013",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "34161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central Texas Community Health Centers
• Central Texas Community Health Centers
• Central Texas Community Health Centers (CommUnityCare)
• Central Texas Diabetes and Nutrition Specialists
• Central Texas Emergency Medical Associates PA
• Central Texas Home Wound Care PLLC
• Central Texas Hospital Physicians
• Central Texas Imaging Group
• Central Texas Integrated Center PLLC
• Central Texas Kidney Assoc PA

• Clinical Psychologist in Austin, TX
• Providers in Austin, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.