Healthcare Provider Details

I. General information

NPI: 1396450623
Provider Name (Legal Business Name): TEALE JANYSEK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 MONTEREY OAKS BLVD
AUSTIN TX
78749-1170
US

IV. Provider business mailing address

948 LONG CREEK BLVD
NEW BRAUNFELS TX
78130-8298
US

V. Phone/Fax

Practice location:
  • Phone: 918-605-3909
  • Fax:
Mailing address:
  • Phone: 918-605-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number61750
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number71001
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: