Provider Demographics
NPI:1386312155
Name:NEDVED, AUSTIN TYLER
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:TYLER
Last Name:NEDVED
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 1:10315 MONROVIA DR APT 308
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5578
Mailing Address - Country:US
Mailing Address - Phone:336-409-9131
Mailing Address - Fax:
Practice Address - Street 1:3800 MEETING ST
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-6582
Practice Address - Country:US
Practice Address - Phone:980-292-1793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16185101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health