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General NPI Number Information
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NPI Number | 1902126683
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Entity Type | Individual
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Provider Name | CAROL ANN JAQUITH LPC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 56 EAST AVE
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City | AUSTIN
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State | TX
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Zip | 78701-4323
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Country | US
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Telephone | 512-703-1312
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Fax | 512-703-1390
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Provider Business Mailing Address
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Address Line | 7807 WILLIAMSON CREEK DR
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City | AUSTIN
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State | TX
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Zip | 78736-2976
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Country | US
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Telephone | 512-940-0191
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 18022
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License Number State | TX
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