Deep Waters Austin LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

71881 Issued in TX

Legal business name

DEEP WATERS AUSTIN LLC

Practice address

13740 Research Blvd Ste N8
Austin, TX 78750-1834

Phone

(512) 939-7769

Fax

(512) 939-7769

NPI assigned

Aug 18, 2017

Last updated

Aug 18, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Merrill Baca Davila, LPCNPI 1578085171

Title

Member

Phone

(512) 939-7769

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Baca LPC Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Merrill Baca Davila, LPC

  • Mental Health Counselor
  • Austin, TX
  • NPI 1578085171
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503014400000",
    "number": "1023534294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 BRENTWOOD DR",
            "city": "LEANDER",
            "state": "TX",
            "postal_code": "786419431",
            "telephone_number": "512-939-7769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13740 RESEARCH BLVD STE N8",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787501834",
            "telephone_number": "512-939-7769",
            "fax_number": "512-939-7769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEP WATERS AUSTIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2017-08-18",
        "status": "A",
        "authorized_official_last_name": "BACA DAVILA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MERRILL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "512-939-7769",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "TX",
            "license": "71881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jennifer Baca LPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Deep Sedation P.C.
• Deepsky Enterprises, PLLC (Nate Havlick, LCSW)
• Tiffany Deer, LCSW
• Debra Deerwester, ARNP
• Ashley M Deese, OD
• Victoria Defeo, O.D.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Austin, TX
• Providers in Austin, TX by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.