Healthcare Provider Details

I. General information

NPI: 1699231142
Provider Name (Legal Business Name): DEBORAH MICHELLE AUSTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 S 100 W
LOGAN UT
84321-5233
US

IV. Provider business mailing address

196 S 100 W
LOGAN UT
84321-5233
US

V. Phone/Fax

Practice location:
  • Phone: 435-268-2348
  • Fax:
Mailing address:
  • Phone: 435-268-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9681554-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: