Active NPI
Annelisa Helene Pedersen, PHD
- Mental Health Counselor
- Austin, TX
National Provider Identifier
1356589683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 2222 Western Trails Blvd Ste 107
Austin, TX 78745-1601 - Phone
- (512) 815-3814
- NPI assigned
- Jan 23, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 38061 | TX | |
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
2222 Western Trails Blvd Ste 107
Austin, TX 78745-1601
Mailing address
2222 Western Trails Blvd Ste 107
Austin, TX 78745-1601
Phone (512) 815-3814
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356589683 | Other | TX | BCBSTX |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38061 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655856000000",
"number": "1356589683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 WESTERN TRAILS BLVD STE 107",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787451601",
"telephone_number": "512-815-3814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 WESTERN TRAILS BLVD STE 107",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787451601",
"telephone_number": "512-815-3814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "ANNELISA",
"middle_name": "HELENE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-23",
"last_updated": "2022-06-22",
"certification_date": "2022-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "38061",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSTX",
"identifier": "1356589683",
"state": "TX"
}
],
"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 Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.