Healthcare Provider Details

I. General information

NPI: 1114141082
Provider Name (Legal Business Name): DARYL WAYNE AUSTIN IX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14277 ROAD 28
MADERA CA
93638-5715
US

IV. Provider business mailing address

1542 CELESTE AVE
CLOVIS CA
93611-1403
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3508
  • Fax: 559-661-2818
Mailing address:
  • Phone: 559-298-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: