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General NPI Number Information
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NPI Number | 1285058123
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Entity Type | Individual
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Provider Name | JEANETTE MAYSE PHD, ABPP
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Gender | Female
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 20901 HUCKABEE BND
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-6566
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Country | US
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Telephone | 979-777-1479
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6273
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City | ROUND ROCK
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State | TX
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Zip | 78683-6273
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Country | US
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Telephone | 979-777-1479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 33945
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License Number State | TX
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