Provider Demographics
NPI:1790325454
Name:LAING, AUSTIN MARK
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:MARK
Last Name:LAING
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 1:354 ORCHALARA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4673
Mailing Address - Country:US
Mailing Address - Phone:208-490-0615
Mailing Address - Fax:
Practice Address - Street 1:354 ORCHALARA AVE APT 3
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4673
Practice Address - Country:US
Practice Address - Phone:208-490-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician