Provider Demographics
NPI:1336307198
Name:AUSTIN, WINNIE A (LMFT)
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:A
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 3RD AVE S STE 303
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1865
Mailing Address - Country:US
Mailing Address - Phone:701-200-4863
Mailing Address - Fax:701-540-0097
Practice Address - Street 1:808 3RD AVE S STE 303
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1865
Practice Address - Country:US
Practice Address - Phone:701-200-4863
Practice Address - Fax:701-540-0097
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2015-049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist