MEDICARE: DR. JUDE THADDEUS AUSTIN II PHD, LPC, LMFT-ASSOC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701008193	VA
2	106H00000X	Marriage & Family Therapist	203451	TX

General Provider Information

NPI Number	:	1275198335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDE THADDEUS AUSTIN II PHD, LPC, LMFT-ASSOC

Provider Business Mailing Address
First Line	:	405 WEEPING WILLOW DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-5301
Country	:	US
Telephone Number	:	337-347-0410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 S 61ST ST STE 121
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-6817
Country	:	US
Telephone Number	:	254-258-4571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2019
Last Update Date	:	05/04/2019

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