Vida Clinic Pllc

LBN: Vida Clinic Pllc
Vida Clinic Pllc is an health care organization with primary practice located at 1221 W Ben White Blvd Ste 210A , Austin TX 78704-7182. The organization recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Agencies / Community/Behavioral Health. Behavioral Health & Social Service Providers / Clinical is the primary health care specialty. Vida Clinic Pllc can be contacted via phone (512) 960-4533, or through Stordahl, Alain via phone (512) 537-7976.

Contact Information

Primary practice address
1221 W Ben White Blvd Ste 210A Austin TX 78704-7182
Phone: (512) 960-4533
Fax: (512) 887-3970
Website:
Map and Directions
Authorized official contact:
Name: Stordahl, Alain
Phone: (512) 537-7976

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 34166 Texas
Agencies / Community/Behavioral Health 251S00000X 34166 Texas

Profile Details

NPI number 1912389081
LBN Legal business name Vida Clinic Pllc
DBA Doing business as
Authorized official Stordahl, Alain
Entity Organization
Organization subpart 1 No
Enumeration date Jun 24th, 2015
Last updated Aug 16th, 2021 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912389081 NPPES
Texas MEDICAID 3572935-01

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