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General NPI Number Information
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NPI Number | 1508216631
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Entity Type | Individual
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Provider Name | KELLY AUSTIN LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 9105A OWENS DR STE 102
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City | MANASSAS PARK
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State | VA
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Zip | 20111-4852
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Country | US
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Telephone | 571-331-9704
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Fax | 855-755-7769
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Provider Business Mailing Address
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Address Line | 7118 KNOTTY OAK LN
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City | MANASSAS
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State | VA
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Zip | 20112-3235
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Country | US
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Telephone | 571-445-0265
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Fax | 855-755-7769
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001391
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License Number State | VA
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