Healthcare Provider Details

I. General information

NPI: 1932766821
Provider Name (Legal Business Name): ROY FAGET LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2019
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 N LAMAR BLVD STE 331
AUSTIN TX
78752-1000
US

IV. Provider business mailing address

7701 N LAMAR BLVD STE 331
AUSTIN TX
78752-1000
US

V. Phone/Fax

Practice location:
  • Phone: 512-810-8347
  • Fax:
Mailing address:
  • Phone: 512-337-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number203122
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number79102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: