Healthcare Provider Details

I. General information

NPI: 1003158197
Provider Name (Legal Business Name): MR. MAURICE AUSTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 15TH ST STE B
MERCED CA
95341-6217
US

IV. Provider business mailing address

PO BOX 2087
MERCED CA
95344-0087
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-6879
  • Fax: 209-725-3775
Mailing address:
  • Phone: 209-381-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: