MEDICARE: RENATA AUSTIN LPC

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	C8995	OR

General Provider Information

NPI Number	:	1790020220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENATA AUSTIN LPC

Provider Business Mailing Address
First Line	:	1644 NW 129TH PL
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-4667
Country	:	US
Telephone Number	:	503-658-9608
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 SE DIVISION ST STE 111
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1042
Country	:	US
Telephone Number	:	503-658-9608
Fax Number	:

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

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	05/19/2025

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