Provider Demographics
NPI:1982431003
Name:AINA, TASIA
Entity type:Individual
Prefix:
First Name:TASIA
Middle Name:
Last Name:AINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12408 DESSAU RD APT 7301
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-2259
Mailing Address - Country:US
Mailing Address - Phone:980-254-2622
Mailing Address - Fax:
Practice Address - Street 1:4105 MEDICAL PKWY STE 202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3725
Practice Address - Country:US
Practice Address - Phone:512-522-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health