Provider Demographics
NPI:1285860049
Name:AUSTIN, KAREN L (EDS, BCABA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:EDS, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 W SAN JUAN ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7802
Mailing Address - Country:US
Mailing Address - Phone:813-453-3512
Mailing Address - Fax:
Practice Address - Street 1:3919 W SAN JUAN ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7802
Practice Address - Country:US
Practice Address - Phone:813-453-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-05-1687103K00000X
FLSS 835103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool