Individual provider Active NPI

Kathleen Fahrner, PH.D.

  • Clinical Psychologist
  • Austin, TX
National Provider Identifier
1477628287
Registry record updated Sep 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
38562 Issued in TX
Practice address
2600 W Stassney LN
Austin, TX 78745-3401
Phone
(512) 956-6463
NPI assigned
Nov 21, 2006
Last updated
Sep 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY1148 NV
Clinical Psychologist 103TC0700X 38562 TX Primary
Counseling Psychologist 103TC1900X PSY14141 CA

Addresses

Primary practice location

2600 W Stassney LN
Austin, TX 78745-3401

Mailing address

2804 Robin Rd
Manchaca, TX 78652-4175
Phone (415) 515-8168

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240509000362 TX Practitioner - Clinical Psychologist 9931540804 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deep Eddy Psychotherapy Management, LLCGroup PAC ID 2264886936, 70 clinicians

Practice addresses (Care Compare)

2600 W Stassney LN
Austin, TX 78745-3401
Phone (512) 956-6463

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY1148NVMDClinical Psychologist
PSY14141CAMDCounseling Psychologist
38562TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Deep Eddy Psychotherapy Management, LLC Clinical CurrentSince Apr 9, 2024 Accepting new patients
Deep Centered Psychiatry PLLC Past Accepting new patients

Locations

2600 W Stassney Ln
Austin, TX 78745
Phone (512) 729-8522

508 Deep Eddy Ave
Austin, TX 78703
Phone (512) 469-0889

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758326400000",
    "number": "1477628287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 ROBIN RD",
            "city": "MANCHACA",
            "state": "TX",
            "postal_code": "786524175",
            "telephone_number": "415-515-8168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 W STASSNEY LN",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787453401",
            "telephone_number": "512-956-6463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHRNER",
        "first_name": "KATHLEEN",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2025-09-20",
        "certification_date": "2025-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY1148",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "38562",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY14141",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.