Provider Demographics
NPI:1629317904
Name:MINARCEK, JETTE STARR (LPCC)
Entity type:Individual
Prefix:
First Name:JETTE
Middle Name:STARR
Last Name:MINARCEK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 LOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-7300
Mailing Address - Country:US
Mailing Address - Phone:513-295-2776
Mailing Address - Fax:
Practice Address - Street 1:2222 WESTERN TRAILS BLVD
Practice Address - Street 2:STE 205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1682
Practice Address - Country:US
Practice Address - Phone:513-295-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC. 1000485101Y00000X
TX70075101YP2500X
OHE.2404801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor