Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | LP-0736 | KS |
NPI | 1003018532 |
---|---|
Provider Name | Austin T Deslauriers |
First Address | Great Bend, KS 67530-9345 |
Second Address | Great Bend, KS 67530-4271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |