Provider Demographics
NPI:1437312071
Name:TOMLINSON, AUSTIN (LMHC, CEAP, SAP, NBC)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:
Last Name:TOMLINSON
Suffix:
Gender:M
Credentials:LMHC, CEAP, SAP, NBC
Other - Prefix:
Other - First Name:WENDELL
Other - Middle Name:AUSTIN
Other - Last Name:TOMLINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, CEAP, SAP, NBC
Mailing Address - Street 1:1727 BLANDING BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1962
Mailing Address - Country:US
Mailing Address - Phone:904-476-4328
Mailing Address - Fax:
Practice Address - Street 1:1727 BLANDING BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1962
Practice Address - Country:US
Practice Address - Phone:904-476-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5955101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health