Provider Demographics
NPI:1043669757
Name:JAKSIK, MICAH (LPC)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:JAKSIK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 POLAR LN STE 407
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3050
Mailing Address - Country:US
Mailing Address - Phone:512-309-1718
Mailing Address - Fax:
Practice Address - Street 1:3016 POLAR LN STE 407
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3050
Practice Address - Country:US
Practice Address - Phone:512-309-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional