Provider Demographics
NPI:1003018532
Name:DESLAURIERS, AUSTIN T (PHD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:T
Last Name:DESLAURIERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 W BARTON COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-9345
Mailing Address - Country:US
Mailing Address - Phone:620-793-9662
Mailing Address - Fax:
Practice Address - Street 1:3111 10TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4271
Practice Address - Country:US
Practice Address - Phone:620-792-5227
Practice Address - Fax:620-793-5666
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP-0736103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral