Healthcare Provider Details

I. General information

NPI: 1417193715
Provider Name (Legal Business Name): AUSTIN & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VESTAVIA PKWY STE 130
VESTAVIA AL
35216-3750
US

IV. Provider business mailing address

400 VESTAVIA PKWY STE 130
VESTAVIA AL
35216-3750
US

V. Phone/Fax

Practice location:
  • Phone: 205-823-2373
  • Fax:
Mailing address:
  • Phone: 205-823-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1360
License Number StateAL

VIII. Authorized Official

Name: DR. HEATHER AUSTIN
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 205-823-2373