Basic Information
| Provider Information | |||||||||
| NPI: | 1215318373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
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| Credential: | BS, CADC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4736 SAN CARLOS CT NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973052633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035597701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3180 CENTER ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035764660 | ||||||||
| FaxNumber: | 5033612688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 06/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 15-04-01 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.