Provider Demographics
NPI:1447574793
Name:AUSTIN, JACQUES L (LPC)
Entity Type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:L
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 1ST ST N
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8702
Mailing Address - Country:US
Mailing Address - Phone:205-266-2352
Mailing Address - Fax:
Practice Address - Street 1:1240 1ST ST N
Practice Address - Street 2:SUITE 209
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8702
Practice Address - Country:US
Practice Address - Phone:205-266-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional