Individual
MR. THOMAS RUSSELL AUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS LADC
Contact information
Practice address
1321 13TH ST N, ST CLOUD, MN 56303-2614
(320) 252-5010
(320) 203-1855
Mailing address
1321 13TH ST N, ST CLOUD, MN 56303-2614
(320) 252-5010
(320) 203-1855
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301751
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
922241043158
PREFERRED ONE
—
01
—
HP50683
HEALTH PARTNERS
—
Enumeration date
06/22/2006
Last updated
07/08/2007
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