Provider Demographics
NPI:1841466018
Name:AUSTIN, VAN O (MD)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:O
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EAST LITTLE COTTONWOOD CANYON ROAD
Mailing Address - Street 2:BOX 920013
Mailing Address - City:SNOWBIRD
Mailing Address - State:UT
Mailing Address - Zip Code:84092-0013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 EAST LITTLE COTTONWOOD CANYON ROAD
Practice Address - Street 2:BOX 920013
Practice Address - City:SNOWBIRD
Practice Address - State:UT
Practice Address - Zip Code:84092-0013
Practice Address - Country:US
Practice Address - Phone:801-891-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15943-1205102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst