MEDICARE: JETTE STARR MINARCEK LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	C. 1000485	OH
2	101YP2500X	Professional Counselor	70075	TX
3	101YP2500X	Professional Counselor	E.2404801	OH

General Provider Information

NPI Number	:	1629317904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JETTE STARR MINARCEK LPCC

Provider Business Mailing Address
First Line	:	670 LOXWOOD LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-7300
Country	:	US
Telephone Number	:	513-295-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 WESTERN TRAILS BLVD
Second Line	:	STE 205
City	:	AUSTIN
State	:	TX
Zip	:	78745-1682
Country	:	US
Telephone Number	:	513-295-2776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	11/15/2024

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