Provider Demographics
NPI:1235458449
Name:AUSTIN, CONNIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 KLEMPNER WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-4203
Mailing Address - Country:US
Mailing Address - Phone:502-452-6341
Mailing Address - Fax:502-452-6718
Practice Address - Street 1:2821 KLEMPNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-4203
Practice Address - Country:US
Practice Address - Phone:502-452-6341
Practice Address - Fax:502-452-6718
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health