Provider Demographics
NPI:1689710212
Name:AUGUSTINE, MOLLY KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHRYN
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 POTOMAC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9317
Mailing Address - Country:US
Mailing Address - Phone:443-392-5561
Mailing Address - Fax:
Practice Address - Street 1:1205 S WHITE CHAPEL BLVD STE 285
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9331
Practice Address - Country:US
Practice Address - Phone:817-527-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR28092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry