Active NPI
Jacy Blake Fisette
- Mental Health Counselor
- Austin, TX
National Provider Identifier
1003603002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 95636
- Practice address
- 2604 Colquitt CV # B
Austin, TX 78748-5952 - Phone
- (512) 809-4757
- NPI assigned
- Apr 22, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 95636 | TX | Primary |
Addresses
Primary practice location
2604 Colquitt CV # B
Austin, TX 78748-5952
Mailing address
2604 Colquitt CV # B
Austin, TX 78748-5952
Phone (512) 809-4757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95636 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745280000000",
"number": "1003603002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2604 COLQUITT CV # B",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787485952",
"telephone_number": "512-809-4757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2604 COLQUITT CV # B",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787485952",
"telephone_number": "512-809-4757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISETTE",
"first_name": "JACY",
"middle_name": "BLAKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-22",
"last_updated": "2025-04-22",
"certification_date": "2025-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "95636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.