Basic Information
| Provider Information | |||||||||
| NPI: | 1336661974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIALA | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | ERNEST | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | EDD,MSN,APRN,PMHNPBC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 SHORELINE DR | ||||||||
| Address2: | APT 1318 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78728 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 SE INNER LOOP | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128199400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2017 | ||||||||
| LastUpdateDate: | 07/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP134450 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.