Kelly Austin, LMFT
Individual provider Active NPI Marriage & Family Therapist · Manassas, VA
NPI 1508216631 · NPPES record last updated Aug 29, 2026
Key facts
- NPI
- 1508216631
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 0717001391 (VA)
- Practice address
- 8781 Mathis Ave
Manassas, VA 20110-5273 - Phone
- (571) 445-0265
- Fax
- (855) 755-7769
- NPI assigned
- Jun 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 8, 2024 through Jan 8, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0717001391 | VA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brookside Family Therapy, LLC | Marriage & Family Therapist | Current |
Accepting new patients |
Locations
9105A Owens Dr
Ste 102
Manassas Park, VA 20111
Phone (571) 331-9704
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 0717001391 | VA | Yes |
Addresses
Primary practice location
8781 Mathis Ave
Manassas, VA 20110-5273
Mailing address
7118 Knotty Oak LN
Manassas, VA 20112-3235
Phone (571) 445-0265
Other practice location 1
7118 Knotty Oak Ln
Manassas, VA 20112-3235
Phone (571) 445-0265
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0717001391 | Other | VA | STATE LICENSE |
Other providers in Manassas, VA
- Audiology and Hearing Aid Center of Gainesville, PLLC
- Wendy Chickering Ault
- Ashley Ausborn
- Danielle M Austin
- Juliane Austin
- Authentic Home Health Services
- Available Home Health Care LLC
- Avea Wellness & Rejuvenation
- Fawn Avery
- Sharon Aviles
All providers in Manassas, VA · Marriage & Family Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.