Healthcare Provider Details

I. General information

NPI: 1265258586
Provider Name (Legal Business Name): NOEL E AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 517
PASADENA CA
91101-2017
US

IV. Provider business mailing address

PO BOX 1075
LOS ANGELES CA
90078-1075
US

V. Phone/Fax

Practice location:
  • Phone: 828-998-4521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAMFT151413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: