Provider Demographics
NPI:1003839614
Name:AUSTIN, JASON WILLIAM (MFT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:WILLIAM
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9584 ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7250
Mailing Address - Country:US
Mailing Address - Phone:714-225-9390
Mailing Address - Fax:
Practice Address - Street 1:17542 IRVINE BLVD
Practice Address - Street 2:#F
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3155
Practice Address - Country:US
Practice Address - Phone:714-508-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34969106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist