Provider Demographics
NPI:1689200966
Name:DONNELL, AUSTIN TAYLOR
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:TAYLOR
Last Name:DONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20818 44TH AVE W STE 270
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7709
Mailing Address - Country:US
Mailing Address - Phone:425-673-6911
Mailing Address - Fax:425-712-0641
Practice Address - Street 1:414 W BAKERVIEW RD STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8180
Practice Address - Country:US
Practice Address - Phone:360-738-9500
Practice Address - Fax:360-738-9501
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61053568106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician