Provider Demographics
NPI:1669950952
Name:AUSTRING, KATIE JOY
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JOY
Last Name:AUSTRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9844 RESEARCH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4381
Mailing Address - Country:US
Mailing Address - Phone:949-859-0443
Mailing Address - Fax:
Practice Address - Street 1:14772 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2622
Practice Address - Country:US
Practice Address - Phone:949-282-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1234Medicaid