Basic Information
| Provider Information | |||||||||
| NPI: | 1871126292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIPTAK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | MSN, PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4005 BANISTER LN STE 200C | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787048077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123287222 | ||||||||
| FaxNumber: | 5123675668 | ||||||||
| Practice Location | |||||||||
| Address1: | 4005 BANISTER LN STE 200C | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787048077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123287222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2020 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1026494 | TX | N | Nursing Service Providers | Registered Nurse | 163W00000X | 465421 | OH | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 1026494 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.