Provider Demographics
NPI:1841025988
Name:FYT CLINIC, PLLC
Entity type:Organization
Organization Name:FYT CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DEGGS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-923-7716
Mailing Address - Street 1:17400 LAKE WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2659
Mailing Address - Country:US
Mailing Address - Phone:512-923-7716
Mailing Address - Fax:
Practice Address - Street 1:10200 W US HIGHWAY 290 STE 12
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-7724
Practice Address - Country:US
Practice Address - Phone:512-923-7716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty