Provider Demographics
NPI:1174260541
Name:PLATT, AUSTIN TYLER
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:TYLER
Last Name:PLATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20506 151ST LN SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-6710
Mailing Address - Country:US
Mailing Address - Phone:253-888-3194
Mailing Address - Fax:
Practice Address - Street 1:20506 151ST LN SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-6710
Practice Address - Country:US
Practice Address - Phone:253-888-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)