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General NPI Number Information
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NPI Number | 1275198335
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Entity Type | Individual
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Provider Name | JUDE THADDEUS AUSTIN II PHD, LPC, LMFT-ASSOC
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Gender | Male
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Dates
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Enumeration Date | 05/04/2019
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Last Update Date | 05/04/2019
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Provider Practice Location Address
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Address Line | 2027 S 61ST ST STE 121
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City | TEMPLE
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State | TX
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Zip | 76504-6817
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Country | US
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Telephone | 254-258-4571
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Fax |
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Provider Business Mailing Address
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Address Line | 405 WEEPING WILLOW DR
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City | TEMPLE
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State | TX
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Zip | 76502-5301
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Country | US
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Telephone | 337-347-0410
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701008193
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 203451
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License Number State | TX
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