Healthcare Provider Details

I. General information

NPI: 1942138029
Provider Name (Legal Business Name): AUSTIN EUBANKS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 DUNBARTON DR
JACKSON MS
39216-5001
US

IV. Provider business mailing address

1920 DUNBARTON DR
JACKSON MS
39216-5001
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-5376
  • Fax: 601-982-5377
Mailing address:
  • Phone: 601-982-5376
  • Fax: 601-982-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM11470
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: