Individual
GWENDOLYN AUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
2030 E BROADWAY BLVD, TUCSON, AZ 85719-5905
(216) 738-9255
Mailing address
102 HARDLEY ST, FORT HUACHUCA, AZ 85613-1135
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-16867
AZ
Other
Enumeration date
06/02/2019
Last updated
06/02/2019
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