Vida Clinic PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

34166 Issued in TX

Legal business name

VIDA CLINIC PLLC

Practice address

1221 W Ben White Blvd Ste 210a
Austin, TX 78704-7182

Phone

(512) 960-4533

Fax

(512) 887-3970

NPI assigned

Jun 24, 2015

Last updated

Aug 16, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alain Stordahl

Title

Business Manager

Phone

(512) 537-7976

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brenda Veronica Garza, LPC

  • Professional Counselor
  • Austin, TX
  • NPI 1568925881
  NPD (past)
• Gloria Mann, LPC

  • Mental Health Counselor
  • Austin, TX
  • NPI 1760822530
  NPD (past)

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1912389081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 W BEN WHITE BLVD STE 210A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787047182",
            "telephone_number": "512-960-4533",
            "fax_number": "512-887-3970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 W BEN WHITE BLVD STE 210A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787047182",
            "telephone_number": "512-960-4533",
            "fax_number": "512-887-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDA CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-24",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "STORDAHL",
        "authorized_official_first_name": "ALAIN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "512-537-7976"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "34166",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TX",
            "license": "34166",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3572935-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victory Medical Center Pharmacy
• Victory Urgent Care LLC
• Victory Weight Loss Medical Services PLLC
• Victory Wound Care
• Vida Chiropractic, PLLC
• Carla Vidal, MS, RD, LD
• Sophia Ivette Vidal
• Donna Jeanne Vidales
• Allison M Vidaurri
• James Anoil Vidrine, LPC-ASSOCIATE

• 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 16, 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.