Healthcare Provider Details

I. General information

NPI: 1487029534
Provider Name (Legal Business Name): CHELSEA FIELDER-JENKS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 BEE CAVES RD BLDG 2 STE 200
AUSTIN TX
78746-5087
US

IV. Provider business mailing address

3624 NORTH HILLS DR. SUITE 201A
AUSTIN TX
78731-5087
US

V. Phone/Fax

Practice location:
  • Phone: 512-306-1394
  • Fax:
Mailing address:
  • Phone: 254-702-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number69697
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: