Healthcare Provider Details

I. General information

NPI: 1790641546
Provider Name (Legal Business Name): ABBY AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 MIGUEL CHAVEZ RD
SANTA FE NM
87505-6914
US

IV. Provider business mailing address

677 FAUST RD UNIT 11
BURLINGTON WI
53105-5628
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-2361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2025-0930
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: