Healthcare Provider Details

I. General information

NPI: 1376150706
Provider Name (Legal Business Name): JACQULYNE RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR # 30914
AUSTIN TX
78731-4257
US

IV. Provider business mailing address

5900 BALCONES DR # 30914
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 210-934-8499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number79461
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number79461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: