Provider Demographics
NPI:1659911154
Name:CEDAR PARK MINDFULNESS COUNSELING
Entity Type:Organization
Organization Name:CEDAR PARK MINDFULNESS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKSIK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:830-456-4101
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health