Provider Demographics
NPI:1821548645
Name:ROBERTS, AUSTIN FARRELL (MED, BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:FARRELL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MED, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23601 56TH AVE W UNIT 4104
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5268
Mailing Address - Country:US
Mailing Address - Phone:425-275-6272
Mailing Address - Fax:
Practice Address - Street 1:20818 44TH AVE W STE 190
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7745
Practice Address - Country:US
Practice Address - Phone:425-673-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60703536106S00000X
WAAB61427616103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician