Individual provider Active NPI

Daniel John Liptak, MSN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Austin, TX
National Provider Identifier
1871126292
Registry record updated Oct 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1026494 Issued in TX
Practice address
4005 Banister LN Ste 200C
Austin, TX 78704-8077
Phone
(512) 328-7222
NPI assigned
Feb 13, 2020
Last updated
Oct 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1026494 TX Primary
Registered Nurse 163W00000X 1026494 TX
Registered Nurse 163W00000X 465421 OH

Addresses

Primary practice location

4005 Banister LN Ste 200C
Austin, TX 78704-8077

Mailing address

4005 Banister LN Ste 200C
Austin, TX 78704-8077
Phone (512) 328-7222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
465421OHMDRegistered Nurse
1026494TXMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Family Mental Health, PA CurrentSince Oct 17, 2021 Accepting new patients

Locations

4005 Banister Ln
Ste 200C
Austin, TX 78704
Phone (512) 328-7222

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1871126292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 BANISTER LN STE 200C",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787048077",
            "telephone_number": "512-328-7222",
            "fax_number": "512-367-5668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 BANISTER LN STE 200C",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787048077",
            "telephone_number": "512-328-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPTAK",
        "first_name": "DANIEL",
        "middle_name": "JOHN",
        "credential": "MSN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-13",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1026494",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "1026494",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "465421",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; 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.