Healthcare Provider Details

I. General information

NPI: 1104654920
Provider Name (Legal Business Name): JENNIFER MARIE FIKE LPC- ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5839 VAN WINKLE LN
AUSTIN TX
78739-1670
US

IV. Provider business mailing address

5839 VAN WINKLE LN
AUSTIN TX
78739-1670
US

V. Phone/Fax

Practice location:
  • Phone: 901-428-8955
  • Fax:
Mailing address:
  • Phone: 901-428-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: