Basic Information
| Provider Information | |||||||||
| NPI: | 1003018532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESLAURIERS | ||||||||
| FirstName: | AUSTIN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 W BARTON COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | GREAT BEND | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675309345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207939662 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3111 10TH ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | GREAT BEND | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675304271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207925227 | ||||||||
| FaxNumber: | 6207935666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 103TB0200X | LP-0736 | KS | Y | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No ID Information.