Basic Information
| Provider Information | |||||||||
| NPI: | 1194490375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRISSELL | ||||||||
| FirstName: | MIKAELA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 TRINITY ST STOP A | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787121766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9177107218 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 TRINITY ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787121765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8338822737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2021 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 62446 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.