Provider Demographics
NPI:1235670365
Name:WHITE AUSTIN, JANICE (IMFT 66759)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:WHITE AUSTIN
Suffix:
Gender:F
Credentials:IMFT 66759
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23201 MILL CREEK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7906
Mailing Address - Country:US
Mailing Address - Phone:888-795-4337
Mailing Address - Fax:949-460-5322
Practice Address - Street 1:23201 MILL CREEK DR STE 220
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7906
Practice Address - Country:US
Practice Address - Phone:888-795-4337
Practice Address - Fax:949-460-5322
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 66759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist