Provider Demographics
NPI:1326312299
Name:PIETIG, CARRIE LYNNE (LPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:PIETIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNNE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4008 GALENA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2616
Mailing Address - Country:US
Mailing Address - Phone:512-799-4875
Mailing Address - Fax:
Practice Address - Street 1:1311 CHISHOLM TRL
Practice Address - Street 2:STE 301
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2968
Practice Address - Country:US
Practice Address - Phone:512-799-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional