Provider Demographics
NPI:1881987287
Name:AUSTIN, ALICE KEYL (PHD, BCBA-D, LBA)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:KEYL
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHD, BCBA-D, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:971-258-5555
Mailing Address - Fax:888-972-1390
Practice Address - Street 1:11481 SW HALL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8403
Practice Address - Country:US
Practice Address - Phone:971-258-5555
Practice Address - Fax:888-972-1390
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10167139103K00000X
1-07-3840103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst