Healthcare Provider Details

I. General information

NPI: 1114428604
Provider Name (Legal Business Name): AUSTIN HERRMANN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 NUECES ST
AUSTIN TX
78705-5537
US

IV. Provider business mailing address

1904 NUECES ST
AUSTIN TX
78705-5537
US

V. Phone/Fax

Practice location:
  • Phone: 919-606-7392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number64468
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: