Provider Demographics
NPI:1609525674
Name:AUSTIN, MARKEYA KEISHONA
Entity Type:Individual
Prefix:
First Name:MARKEYA
Middle Name:KEISHONA
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 FOREST DALE LN APT 3206
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-3019
Mailing Address - Country:US
Mailing Address - Phone:469-468-4046
Mailing Address - Fax:
Practice Address - Street 1:2503 FOREST DALE LN APT 3206
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-3019
Practice Address - Country:US
Practice Address - Phone:469-468-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty