Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 69761 | TX |
NPI | 1003248469 |
---|---|
Provider Name | Jessica Lynn Stewart |
First Address | Austin, TX 78704-2911 |
Second Address | Austin, TX 78744-2713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2013 |
Last Update Date | 31/08/2015 |