Provider Demographics
NPI:1023605797
Name:HARWARD, AUSTIN LAVERE
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:LAVERE
Last Name:HARWARD
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 1:3396 W PORTER CIR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-2758
Mailing Address - Country:US
Mailing Address - Phone:435-406-4735
Mailing Address - Fax:
Practice Address - Street 1:1441 E FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-2847
Practice Address - Country:US
Practice Address - Phone:385-695-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12147016103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst