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General NPI Number Information
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NPI Number | 1083166441
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Entity Type | Organization
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Legal Business Name | JESSICA MEDLYN
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 12335 HYMEADOW DR STE 300
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City | AUSTIN
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State | TX
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Zip | 78750-1934
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Country | US
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Telephone | 512-585-9442
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 ALGUNO RD APT B
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City | AUSTIN
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State | TX
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Zip | 78757-3221
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Country | US
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Telephone | 512-585-9442
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | JESSICA L MEDLYN
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Credential | LPC
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Telephone | 512-585-9442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 70948
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License Number State | TX
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