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General NPI Number Information
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NPI Number | 1053124941
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Entity Type | Individual
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Provider Name | ROBERT WAYNE AUSTIN
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Gender | Male
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 818 N UNIVERSITY DR STE 202
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4681
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Country | US
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Telephone | 903-561-8955
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 FM 698
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City | NACOGDOCHES
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State | TX
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Zip | 75964-4395
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Country | US
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Telephone | 936-615-0736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 91091
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License Number State | TX
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