Kyler Shumway

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

38635 Issued in TX

Practice address

508 Deep Eddy Ave
Austin, TX 78703-4555

Phone

(503) 403-9397

NPI assigned

Jan 13, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Deep Eddy Psychotherapy Management, LLC

  • Counseling Psychologist
  • Austin, TX
  • NPI 1457740862

  Clinical

  Medicare reassignment NPD
• Time Mental Health, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Round Rock, TX
  • NPI 1326846684

  Clinical

  NPD Authorized official
• Deep Centered Psychiatry PLLC

  • Psychiatry Physician
  • Austin, TX
  • NPI 1629853825
  NPD (past)

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1427414952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 DEEP EDDY AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787034555",
            "telephone_number": "503-403-9397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 DEEP EDDY AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787034555",
            "telephone_number": "503-403-9397"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "414 N Meridian St",
            "address_2": "#V104",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971322697",
            "country_code": "US",
            "telephone_number": "503-403-9397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUMWAY",
        "first_name": "KYLER",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-13",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "38635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shults Partners, Inc
• James Michael Shultz, MD
• Shannon Leigh Shumaker, LCSW
• Clint Lane Shuman, LAT, ATC
• Jenna Grace Shumate
• McKay Shumway, MS
• Sheila Shung, M.D.
• Brenda Elizabeth Shunn, LPT, RMT
• Sharon Shuppert, M.S., L.AC.
• Kaleigh Shuster, MA, CCC-SLP

• Clinical Psychologist in Austin, TX
• Providers in Austin, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.