Healthcare Provider Details

I. General information

NPI: 1740184399
Provider Name (Legal Business Name): MARY KEMMY FAJARDO LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 S CONGRESS AVE APT 4417
AUSTIN TX
78745-7700
US

IV. Provider business mailing address

8200 S CONGRESS AVE APT 4417
AUSTIN TX
78745-7700
US

V. Phone/Fax

Practice location:
  • Phone: 210-556-9566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: