Healthcare Provider Details

I. General information

NPI: 1174845127
Provider Name (Legal Business Name): HARLAN ROSS AUSTIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BUCK CREEK RD STE 200
AVON CO
81620-5428
US

IV. Provider business mailing address

1693 QUENTIN ST CEDAR
AURORA CO
80045-2518
US

V. Phone/Fax

Practice location:
  • Phone: 970-926-6340
  • Fax: 970-926-6348
Mailing address:
  • Phone: 720-848-3078
  • Fax: 720-848-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0004247
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: