Healthcare Provider Details

I. General information

NPI: 1942447917
Provider Name (Legal Business Name): CANDICE KAY FRASER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 DAWN DR STE 108
GEORGETOWN TX
78628-2800
US

IV. Provider business mailing address

3003 DAWN DR STE 108
GEORGETOWN TX
78628-2800
US

V. Phone/Fax

Practice location:
  • Phone: 512-572-1352
  • Fax:
Mailing address:
  • Phone: 512-572-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: