Active NPI
Jessica A Peller, PSYD
- Clinical Psychologist
- Austin, TX
National Provider Identifier
1386161750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 37503
- Practice address
- 9701 Brodie LN Ste 205
Austin, TX 78748-6284 - Phone
- (512) 420-8444
- Fax
- (512) 233-2961
- NPI assigned
- Aug 27, 2017
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 37503 | TX | Primary |
Addresses
Primary practice location
9701 Brodie LN Ste 205
Austin, TX 78748-6284
Mailing address
9701 Brodie LN Ste 205
Austin, TX 78748-6284
Phone (512) 420-8444
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37503 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667865600000",
"number": "1386161750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9701 BRODIE LN STE 205",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787486284",
"telephone_number": "512-420-8444",
"fax_number": "512-233-2961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9701 BRODIE LN STE 205",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787486284",
"telephone_number": "512-420-8444",
"fax_number": "512-233-2961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLER",
"first_name": "JESSICA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-27",
"last_updated": "2022-11-08",
"certification_date": "2022-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "37503",
"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 Nov 8, 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.