Provider Demographics
NPI:1063525517
Name:AUSTIN, HEATHER (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 8TH CT S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3616
Mailing Address - Country:US
Mailing Address - Phone:205-223-3080
Mailing Address - Fax:
Practice Address - Street 1:400 VESTAVIA PKWY STE 130
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3750
Practice Address - Country:US
Practice Address - Phone:205-823-2373
Practice Address - Fax:205-823-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-33657OtherBCBS
AL515-90550OtherFEDERAL BC
AL101801Medicaid
AL1063525517OtherTRICARE SOUTH
AL515-90549OtherFEDERAL BC
AL890017030Medicaid