Provider Demographics
NPI:1265859474
Name:AUSTIN, TANESHA
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24648
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77229-4648
Mailing Address - Country:US
Mailing Address - Phone:832-470-5764
Mailing Address - Fax:832-404-2442
Practice Address - Street 1:5010 LAURA LEE LN
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2380
Practice Address - Country:US
Practice Address - Phone:832-275-2505
Practice Address - Fax:713-750-9187
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1265859474Medicaid