| Jessica Valencia-fagot, Ph.d. | |
|
5401 Fm 1626 Ste 170-279 Kyle TX 78640-6038 | |
| (512) 643-5101 | |
| Not Available |
| Full Name | Jessica Valencia-fagot, Ph.d. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5401 Fm 1626 Ste 170-279, Kyle, Texas |
| Authorized Official Name and Position | Jessica Marie Valencia-fagot (PSYCHOLOGIST) |
| Authorized Official Contact | 5126435101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Valencia-fagot, Ph.d. 5401 Fm 1626 Ste 170-279 Kyle TX 78640-6038 Ph: (512) 643-5101 | Jessica Valencia-fagot, Ph.d. 5401 Fm 1626 Ste 170-279 Kyle TX 78640-6038 Ph: (512) 643-5101 |
| NPI Number | 1922773456 |
|---|---|
| Provider Enumeration Date | 08/16/2021 |
| Last Update Date | 06/11/2024 |
| Certification Date | 06/11/2024 |
| Medicare PECOS PAC ID | 5799180881 |
|---|---|
| Medicare Enrollment ID | O20210827001650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922773456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jessica Marie Valencia Fagot |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053731018 PECOS PAC ID: 6608271796 Enrollment ID: I20210827002083 |
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