Provider Demographics
NPI:1457515934
Name:AUSTIN, TAMMY M (LMHC)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:M
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S SEMORAN BLVD STE 1093
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5524
Mailing Address - Country:US
Mailing Address - Phone:407-678-9800
Mailing Address - Fax:
Practice Address - Street 1:1025 S SEMORAN BLVD
Practice Address - Street 2:SUITE 1093
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5523
Practice Address - Country:US
Practice Address - Phone:407-678-9800
Practice Address - Fax:407-315-0048
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11794876OtherCAQH