MEDICARE: ENSEMBLE THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588225908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENSEMBLE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	4210 SPICEWOOD SPRINGS RD STE 203
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8654
Country	:	US
Telephone Number	:	512-766-3623
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 SPICEWOOD SPRINGS RD STE 203
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8654
Country	:	US
Telephone Number	:	512-766-3623
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, CEO
Name	:	JACLYN SEPP
Credential	:	LPC-S, RPT-S, NCC
Telephone Number	:	512-766-4340

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	10/10/2024

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