Polaris Therapy, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

POLARIS THERAPY, LLC

Practice address

1704 W Koenig LN
Austin, TX 78756-1207

Phone

(307) 287-2639

NPI assigned

Nov 2, 2023

Organization subpart

No

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

Authorized official

Name

Andrew Davis, LCSW-SNPI 1417421009

Title

Therapist

Phone

(307) 287-2639

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Davis

  • Clinical Social Worker
  • Austin, TX
  • NPI 1417421009
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1698883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1386417210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 LIGHT TIMBER RD",
            "city": "MAXWELL",
            "state": "TX",
            "postal_code": "786564405",
            "telephone_number": "307-287-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 W KOENIG LN",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787561207",
            "telephone_number": "307-287-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLARIS THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-02",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "307-287-2639",
        "authorized_official_credential": "LCSW-S"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neema Pokhrel, DMD
• Cynthia Pokluda
• Rebecca Lynn Pokluda, MOTR
• David Polanco, CPO
• Katelynn Monique Polanco
• Sarah Polatov
• Soumya Lakshmi Polavarapu, DO
• Rainer N. Poley, M.D.
• Katherine Cook Poliner, MD
• John Politz, M.D.

• Clinical Social Worker in Austin, TX
• Providers in Austin, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.