Healthcare Provider Details

I. General information

NPI: 1477441400
Provider Name (Legal Business Name): JAQUELINE LEE OLVERA LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 W SLAUGHTER LN STE 130
AUSTIN TX
78748-6904
US

IV. Provider business mailing address

8003 S INTERSTATE 35 APT 2934
AUSTIN TX
78744-0091
US

V. Phone/Fax

Practice location:
  • Phone: 512-640-2134
  • Fax:
Mailing address:
  • Phone: 361-401-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number98977
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: