Basic Information
| Provider Information | |||||||||
| NPI: | 1891065694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | LEON | ||||||||
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| Credential: | PSY.D., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2683 W BUCHANAN RD | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488479640 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 116 W SUPERIOR ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895760554 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2012 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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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 | 103T00000X | 6301013213 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.