Healthcare Provider Details

I. General information

NPI: 1306755939
Provider Name (Legal Business Name): AUNDREA DENETTE AUSTIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E PALM LN STE 255
PHOENIX AZ
85004-4604
US

IV. Provider business mailing address

340 E PALM LN STE 255
PHOENIX AZ
85004-4604
US

V. Phone/Fax

Practice location:
  • Phone: 602-918-3664
  • Fax: 480-681-1916
Mailing address:
  • Phone: 602-918-3664
  • Fax: 480-681-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-22538
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: