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General NPI Number Information
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NPI Number | 1386321701
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Entity Type | Individual
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Provider Name | ALEXA ELISE AUSTIN SSP (ED.S.)
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Gender | Female
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 602 WHISPERING WATERS AVE
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City | GONZALES
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State | LA
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Zip | 70737-3174
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Country | US
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Telephone | 337-304-7993
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Fax |
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Provider Business Mailing Address
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Address Line | 602 WHISPERING WATERS AVE
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City | GONZALES
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State | LA
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Zip | 70737-3174
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Country | US
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Telephone | 337-304-7993
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | LSSP045
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License Number State | LA
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