Deep Eddy Psychotherapy Management, LLC
Organization Active NPI Counseling Psychologist · Austin, TX
NPI 1457740862 · NPPES record last updated Dec 27, 2022
Key facts
- NPI
- 1457740862
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Counseling Psychologist 103TC1900X
- License
- 34890 (TX)
- Legal business name
- DEEP EDDY PSYCHOTHERAPY MANAGEMENT, LLC
- Practice address
- 508 Deep Eddy Ave.
Austin, TX 78703 - Phone
- (512) 956-6463
- Fax
- (512) 428-8100
- NPI assigned
- Jan 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Glenn R. Olds, PH.D.
- Title
- Managing Psychologist
- Phone
- (512) 217-9579
Practitioners 134
-
Kathryn J Adams, LPC-ASSOCIATE
-
Abigail Ruth Alford, LPC
-
Bridget Aureli, LPC
-
Lissa Ann Cameron-Giacco, LCSW
-
Taylor Renee Cardenas, LCSW-S
-
Ana Karen De Leon, LPC
-
Aaron Dembe, PHD
-
Charles Earl Everett III, LCSW
-
Kathleen Fahrner, PH.D.
-
Laura Forrester, LPC-S
-
Bethany Jane Frye, LCSW-S, LCDC
-
Christina Galindo, LPC
-
Kelsey Williams Gibbs, LCSW
-
Lori Gonzalez, LCDC
-
Dulce Hernandez, LMFT-S
-
Alexi D Hoefer, LCSW
-
Casey Nicole Janes, MA. LCSW
-
Gabrielle Tolentino Javier, MS, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230928002745 | TX | Part B Supplier - Clinic/Group Practice | 2264886936 |
Receives reassigned benefits from 109 practitioners Practice locations: Rockwall, TX; Austin, TX; San Antonio, TX; Round Rock, TX; Rollingwood, TX; Plano, TX; McKinney, TX; Houston, TX… |
National Provider Directory
Locations
1500 W 38th St
Ste 44
Austin, TX 78731
Phone (512) 469-0889
4144 N Central Expy
Ste 850
Dallas, TX 75204
Phone (214) 531-4943
101 S Locust St
Ste 602
Denton, TX 76201
Phone (512) 782-8108
4119 Montrose Blvd
Ste 500
Houston, TX 77006
Phone (512) 456-9183
2600 Eldorado Pkwy
Ste 240
McKinney, TX 75070
5445 Legacy Dr
Ste 270
Plano, TX 75024
Phone (682) 999-8201
500 Turtle Cove Blvd
Ste 101
Rockwall, TX 75087
Phone (817) 907-5051
1010 W Ralph Hall Pkwy
Ste 112
Rockwall, TX 75032
Phone (469) 442-7366
1922 Dry Creek Way
Ste 108
San Antonio, TX 78259
Phone (512) 887-3993
17806 Ih 10 W
Ste 312
San Antonio, TX 78257
Phone (512) 610-1942
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 21274 | TX | |
| Counseling Psychologist |
103TC1900X | 34890 | TX | Yes |
| Counseling Psychologist |
103TC1900X | 34301 | TX | |
| Counseling Psychologist |
103TC1900X | 20938 | TX | |
| Counseling Psychologist |
103TC1900X | 33076 | TX |
Addresses
Primary practice location
508 Deep Eddy Ave.
Austin, TX 78703
Mailing address
508 Deep Eddy Ave.
Austin, TX 78703
Phone (512) 461-0239
Other names
- Deep Eddy Psychotherapy, PLLC
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.