Healthcare Provider Details

I. General information

NPI: 1285367243
Provider Name (Legal Business Name): CARLY AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 W 6TH ST
JUNCTION CITY KS
66441-3229
US

IV. Provider business mailing address

924 W 6TH ST
JUNCTION CITY KS
66441-3229
US

V. Phone/Fax

Practice location:
  • Phone: 785-256-9096
  • Fax:
Mailing address:
  • Phone: 785-256-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: