Provider Demographics
NPI:1649691213
Name:AUSTIN, HENRY SR
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:AUSTIN
Suffix:SR
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 1:3949 W ALEXANDER RD UNIT 1121
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2913
Mailing Address - Country:US
Mailing Address - Phone:702-638-1664
Mailing Address - Fax:
Practice Address - Street 1:3949 W ALEXANDER RD UNIT 1121
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2913
Practice Address - Country:US
Practice Address - Phone:702-638-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health