Provider Demographics
NPI:1336966365
Name:ISTRE, AUSTIN (LPC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:ISTRE
Suffix:
Gender:X
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-6312
Mailing Address - Country:US
Mailing Address - Phone:337-274-3414
Mailing Address - Fax:
Practice Address - Street 1:820 ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-6312
Practice Address - Country:US
Practice Address - Phone:337-274-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8940101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health