Healthcare Provider Details

I. General information

NPI: 1699681114
Provider Name (Legal Business Name): MR. AUSTIN MICHAEL PASCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7325
US

IV. Provider business mailing address

1233 GIROG AVE
PORT ORANGE FL
32129-6046
US

V. Phone/Fax

Practice location:
  • Phone: 386-957-1854
  • Fax:
Mailing address:
  • Phone: 859-421-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: