Markus Miller Provence, PHD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

37537 Issued in TX

Practice address

2600 W Stassney LN
Austin, TX 78745-3401

Phone

(650) 248-7274

NPI assigned

Apr 8, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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

Specialty

Clinical Psychologist

Education

Other, 2016

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)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 Care Compare group NPD
• 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": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1952920100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 FLATLAND TRL",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786663296",
            "telephone_number": "650-248-7274"
        },
        {
            "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": "650-248-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCE",
        "first_name": "MARKUS",
        "middle_name": "MILLER",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-08",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "37537",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "TX",
            "license": "37537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Anthony Prosk, MSN, APRN, PMHNP-BC
• Prosperity Psychotherapy, PLLC
• Prosthodontics of Texas P.C.
• David James Prout, LMT
• Vincent Edward Provasek, MDPHD
• Providacare Medical Supply LTD
• Providacare Medical Supply LTD
• Providence Service Corporation of Texas
• Provident Memory Care Group, LLC
• Providers 2 You, PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.