Healthcare Provider Details

I. General information

NPI: 1891413258
Provider Name (Legal Business Name): AUSTIN GAYNE CHENOWETH LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 S WINCHESTER BLVD STE 110
SAN JOSE CA
95128-3908
US

IV. Provider business mailing address

6203 SAN IGNACIO AVE STE 150
SAN JOSE CA
95119-1371
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 408-284-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: