Provider Demographics
NPI:1881694610
Name:AUSTIN, HENRY FERRIS (LCSW)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:FERRIS
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR
Mailing Address - Street 2:SUITE 562
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4812
Mailing Address - Country:US
Mailing Address - Phone:502-896-1850
Mailing Address - Fax:502-896-6863
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE 562
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-896-1850
Practice Address - Fax:502-896-6863
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY06391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCSW0076Medicare PIN