Provider Demographics
NPI:1205409596
Name:BOX, AUSTIN DAVID (MS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DAVID
Last Name:BOX
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 S TROOST AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-6034
Mailing Address - Country:US
Mailing Address - Phone:405-760-4773
Mailing Address - Fax:
Practice Address - Street 1:2529 S. KELLEY AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-906-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional