Provider Demographics
NPI:1114579547
Name:AUSTIN, JAMES E
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 COLLINS RD NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8815
Mailing Address - Country:US
Mailing Address - Phone:740-277-7963
Mailing Address - Fax:740-277-6089
Practice Address - Street 1:1434 COLLINS RD NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-277-7963
Practice Address - Fax:740-277-6089
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHC.1902366101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator