Provider Demographics
NPI:1588225908
Name:ENSEMBLE THERAPY, PLLC
Entity Type:Organization
Organization Name:ENSEMBLE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPP
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, PRT, NCC
Authorized Official - Phone:512-762-4030
Mailing Address - Street 1:1213 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3102
Mailing Address - Country:US
Mailing Address - Phone:512-762-4030
Mailing Address - Fax:
Practice Address - Street 1:1213 W 49TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3102
Practice Address - Country:US
Practice Address - Phone:512-762-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty