Healthcare Provider Details

I. General information

NPI: 1972055234
Provider Name (Legal Business Name): JODA KAY MIURA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODA KAY HISLE LMSW, LCSW

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CYPRESS CREEK ROAD SUITE 403
CEDAR PARK TX
78613
US

IV. Provider business mailing address

4820 MORESE PLACE TRAIL
ROUND ROCK TX
78665
US

V. Phone/Fax

Practice location:
  • Phone: 513-323-6994
  • Fax: 512-323-9490
Mailing address:
  • Phone: 859-519-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112085
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7934
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11112
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: