Healthcare Provider Details

I. General information

NPI: 1821573791
Provider Name (Legal Business Name): AUSTIN MILLET
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4185 SW RESEARCH WAY
CORVALLIS OR
97333-1783
US

IV. Provider business mailing address

1825 NW BUCHANAN AVE
CORVALLIS OR
97330-5756
US

V. Phone/Fax

Practice location:
  • Phone: 541-393-5983
  • Fax: 541-393-5984
Mailing address:
  • Phone: 801-921-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2940
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: