Provider Demographics
NPI:1275198335
Name:AUSTIN, JUDE THADDEUS II (PHD, LPC, LMFT-ASSOC)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:THADDEUS
Last Name:AUSTIN
Suffix:II
Gender:M
Credentials:PHD, LPC, LMFT-ASSOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WEEPING WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5301
Mailing Address - Country:US
Mailing Address - Phone:337-347-0410
Mailing Address - Fax:
Practice Address - Street 1:2027 S 61ST ST STE 121
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6817
Practice Address - Country:US
Practice Address - Phone:254-258-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008193101YM0800X
TX203451106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health