Individual
JACY BLAKE FISETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2604 COLQUITT CV # B, AUSTIN, TX 78748-5952
(512) 809-4757
Mailing address
2604 COLQUITT CV # B, AUSTIN, TX 78748-5952
(512) 809-4757
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
95636
TX
Other
Enumeration date
04/22/2025
Last updated
04/22/2025
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