Provider Demographics
NPI:1659306983
Name:BERNARDIN, GUERIN AUGUSTUS III (PSY D)
Entity Type:Individual
Prefix:
First Name:GUERIN
Middle Name:AUGUSTUS
Last Name:BERNARDIN
Suffix:III
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:G
Other - Middle Name:A
Other - Last Name:BERNARDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSY D
Mailing Address - Street 1:11211 TAYLOR DRAPER LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3916
Mailing Address - Country:US
Mailing Address - Phone:512-343-8850
Mailing Address - Fax:512-343-8079
Practice Address - Street 1:11211 TAYLOR DRAPER LN
Practice Address - Street 2:SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3916
Practice Address - Country:US
Practice Address - Phone:512-343-8850
Practice Address - Fax:512-343-8079
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079974401Medicaid
TX079974401Medicaid
P75702Medicare UPIN