Provider Demographics
NPI:1053124941
Name:AUSTIN, ROBERT WAYNE
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAYNE
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FM 698
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-4395
Mailing Address - Country:US
Mailing Address - Phone:936-615-0736
Mailing Address - Fax:
Practice Address - Street 1:818 N UNIVERSITY DR STE 202
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4681
Practice Address - Country:US
Practice Address - Phone:903-561-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional