Healthcare Provider Details

I. General information

NPI: 1417320763
Provider Name (Legal Business Name): JESSICA WANSART LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 BEE CAVES RD # 200
AUSTIN TX
78746-5004
US

IV. Provider business mailing address

1410 ASHWOOD RD # A
AUSTIN TX
78722-1506
US

V. Phone/Fax

Practice location:
  • Phone: 512-306-1394
  • Fax:
Mailing address:
  • Phone: 603-498-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number59860
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: