Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103K00000X | Behavior Analyst | CA |
NPI | 1003158197 |
---|---|
Provider Name | Mr. Maurice Austin |
First Address | Merced, CA 95344-0087 |
Second Address | Merced, CA 95341-6217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 30/10/2020 |