Provider Demographics
NPI:1063813202
Name:AUSTIN, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:AUSTIN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, LCSW, LCDC
Mailing Address - Street 1:8405 BENT TREE RD
Mailing Address - Street 2:APT. 3412
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8265
Mailing Address - Country:US
Mailing Address - Phone:512-791-8035
Mailing Address - Fax:
Practice Address - Street 1:8405 BENT TREE RD
Practice Address - Street 2:APT. 3412
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8265
Practice Address - Country:US
Practice Address - Phone:512-791-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical