Provider Demographics
NPI:1619458312
Name:AUSTIN, CARLEASE MONIQUE
Entity Type:Individual
Prefix:
First Name:CARLEASE
Middle Name:MONIQUE
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 1:1400 N STATE HIGHWAY 360 APT 1628
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3535
Mailing Address - Country:US
Mailing Address - Phone:918-995-9144
Mailing Address - Fax:
Practice Address - Street 1:1400 N STATE HIGHWAY 360 APT 1628
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3535
Practice Address - Country:US
Practice Address - Phone:918-995-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker