Healthcare Provider Details

I. General information

NPI: 1427860998
Provider Name (Legal Business Name): LACIE LEE JASSO MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13441 CARTER CV
SAINT HEDWIG TX
78152-0398
US

IV. Provider business mailing address

13441 CARTER CV
SAINT HEDWIG TX
78152-0398
US

V. Phone/Fax

Practice location:
  • Phone: 210-854-9151
  • Fax:
Mailing address:
  • Phone: 210-854-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: