Healthcare Provider Details

I. General information

NPI: 1891410908
Provider Name (Legal Business Name): JACQUELINE MAYE LPC-S; LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE GILMER

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 ALBERT RD
AUSTIN TX
78745-6101
US

IV. Provider business mailing address

4168 COUNTY ROAD 444
WAELDER TX
78959-5328
US

V. Phone/Fax

Practice location:
  • Phone: 512-630-5751
  • Fax:
Mailing address:
  • Phone: 512-630-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13645
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number73705
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: