Provider Demographics
NPI:1457680670
Name:AUSTIN, CRISTINA (PY60300507)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PY60300507
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31919 1ST AVE S
Mailing Address - Street 2:STE 203
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5236
Mailing Address - Country:US
Mailing Address - Phone:253-839-4172
Mailing Address - Fax:
Practice Address - Street 1:31919 1ST AVE S
Practice Address - Street 2:STE 203
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5236
Practice Address - Country:US
Practice Address - Phone:253-839-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60300507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical