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General NPI Number Information
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NPI Number | 1841025988
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Entity Type | Organization
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Legal Business Name | FYT CLINIC, PLLC
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 10200 W US HIGHWAY 290 STE 12
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City | AUSTIN
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State | TX
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Zip | 78736-7724
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Country | US
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Telephone | 512-923-7716
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Fax |
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Provider Business Mailing Address
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Address Line | 17400 LAKE WOOD CIR
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-2659
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Country | US
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Telephone | 512-923-7716
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BILL LEE DEGGS
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Credential | LPC
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Telephone | 512-923-7716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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