| Deep Eddy Psychotherapy Management, Llc | |
|
508 Deep Eddy Ave. Austin TX 78703 | |
| (512) 956-6463 | |
| (512) 428-8100 |
| Full Name | Deep Eddy Psychotherapy Management, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 508 Deep Eddy Ave., Austin, Texas |
| Authorized Official Name and Position | Glenn R. Olds (MANAGING PSYCHOLOGIST) |
| Authorized Official Contact | 5122179579 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deep Eddy Psychotherapy Management, Llc 508 Deep Eddy Ave. Austin TX 78703 Ph: (512) 461-0239 | Deep Eddy Psychotherapy Management, Llc 508 Deep Eddy Ave. Austin TX 78703 Ph: (512) 956-6463 |
| NPI Number | 1457740862 |
|---|---|
| Provider Enumeration Date | 01/22/2015 |
| Last Update Date | 12/27/2022 |
| Certification Date | 12/27/2022 |
| Medicare PECOS PAC ID | 2264886936 |
|---|---|
| Medicare Enrollment ID | O20230928002745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457740862 | NPI | - | NPPES |
| Provider Name | Kelly M Hays |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205892619 PECOS PAC ID: 9830089234 Enrollment ID: I20040318001093 |
| Provider Name | Caitlin Coyner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629479191 PECOS PAC ID: 8527382258 Enrollment ID: I20150128001451 |
| Provider Name | Mary K Owen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558442491 PECOS PAC ID: 8921309014 Enrollment ID: I20151215000086 |
| Provider Name | Leslee A Fray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134230519 PECOS PAC ID: 1052695301 Enrollment ID: I20170304000093 |
| Provider Name | Steffanie S Strawbridge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265810014 PECOS PAC ID: 7810264090 Enrollment ID: I20170518000117 |
| Provider Name | Vincent T Hochstatter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649784265 PECOS PAC ID: 9739447095 Enrollment ID: I20171215000317 |
| Provider Name | Rachel Mccarthy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982956165 PECOS PAC ID: 9234463597 Enrollment ID: I20190620002447 |
| Provider Name | Charles E Everett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386242386 PECOS PAC ID: 3577973486 Enrollment ID: I20201104002151 |
| Provider Name | Jovita Gutierrez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871101386 PECOS PAC ID: 4587073150 Enrollment ID: I20210511003136 |
| Provider Name | Gina L Warr |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780849166 PECOS PAC ID: 8527420082 Enrollment ID: I20230815002669 |
| Provider Name | Tralynza Lashae Conley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992443790 PECOS PAC ID: 2567826423 Enrollment ID: I20230911002142 |
| Provider Name | Kyler Shumway |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427414952 PECOS PAC ID: 8123477973 Enrollment ID: I20231206000306 |
| Provider Name | Christian Elizabeth Ammons |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174200661 PECOS PAC ID: 9638518350 Enrollment ID: I20240415001705 |
| Provider Name | Bridget Aureli |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699373506 PECOS PAC ID: 0648619304 Enrollment ID: I20240415003468 |
| Provider Name | Jessica Schwen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437830114 PECOS PAC ID: 5991144479 Enrollment ID: I20240416004419 |
| Provider Name | Sheena Pooneh Yazdandoost |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407486434 PECOS PAC ID: 0446699946 Enrollment ID: I20240417000688 |
| Provider Name | Allison Millette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548920218 PECOS PAC ID: 8426497942 Enrollment ID: I20240417001629 |
| Provider Name | Ryan M Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245677566 PECOS PAC ID: 5597104026 Enrollment ID: I20240417001776 |
| Provider Name | Audriana Sarmiento |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265208987 PECOS PAC ID: 7012356546 Enrollment ID: I20240417001844 |
| Provider Name | Elan Elena Lepovic |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811335037 PECOS PAC ID: 9537508932 Enrollment ID: I20240418001131 |
| Provider Name | Andrea P Greebon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194058065 PECOS PAC ID: 1759720162 Enrollment ID: I20240418001450 |
| Provider Name | Dane Deciero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790174852 PECOS PAC ID: 4082053491 Enrollment ID: I20240418001634 |
| Provider Name | Kimberly Mcgoey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922614486 PECOS PAC ID: 4587003900 Enrollment ID: I20240418001903 |
| Provider Name | Matthew D. Halvorson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134629470 PECOS PAC ID: 7113366535 Enrollment ID: I20240418001911 |
| Provider Name | Megan Holden Brissenden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285864603 PECOS PAC ID: 1658710975 Enrollment ID: I20240419001488 |
| Provider Name | Mary Walke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821744103 PECOS PAC ID: 4587058763 Enrollment ID: I20240419002264 |
| Provider Name | Rebekah Kate Coffield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619627726 PECOS PAC ID: 6204275449 Enrollment ID: I20240419002614 |
| Provider Name | Sarah Tresca |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093867988 PECOS PAC ID: 3577902733 Enrollment ID: I20240419003008 |
| Provider Name | Chantail Banks Green |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851018048 PECOS PAC ID: 6507205762 Enrollment ID: I20240419003280 |
| Provider Name | Merrik Laine Hetherington |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386238673 PECOS PAC ID: 1456790633 Enrollment ID: I20240421000080 |
| Provider Name | Bethel Sharon Moges |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336882406 PECOS PAC ID: 6901245117 Enrollment ID: I20240422001136 |
| Provider Name | Nicole Gayleen Porterpan-cassell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811763436 PECOS PAC ID: 5193164200 Enrollment ID: I20240422001499 |
| Provider Name | Anna Sophia Moscow Cohen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457012072 PECOS PAC ID: 3779922802 Enrollment ID: I20240422002197 |
| Provider Name | Jennifer Gonzalez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609235548 PECOS PAC ID: 8729427869 Enrollment ID: I20240422002395 |
| Provider Name | Mamta Chhabra |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205089430 PECOS PAC ID: 4880033943 Enrollment ID: I20240422003369 |
| Provider Name | Brenda Gomez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316661762 PECOS PAC ID: 2860831955 Enrollment ID: I20240423001004 |
| Provider Name | Christina Galindo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104539899 PECOS PAC ID: 4183063183 Enrollment ID: I20240423002156 |
| Provider Name | Tracy Keating Ward |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497081244 PECOS PAC ID: 7012356041 Enrollment ID: I20240423002820 |
| Provider Name | Aaron Dembe |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740991744 PECOS PAC ID: 0749629707 Enrollment ID: I20240423004338 |
| Provider Name | David Alexander Sands |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578277174 PECOS PAC ID: 3476992439 Enrollment ID: I20240423004347 |
| Provider Name | Gabrielle Tolentino Javier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831771237 PECOS PAC ID: 9537509583 Enrollment ID: I20240424003721 |
| Provider Name | Elizabeth Hamburg Ford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538695986 PECOS PAC ID: 1951741834 Enrollment ID: I20240425000838 |
| Provider Name | Krystal Humphrey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861745341 PECOS PAC ID: 6103266085 Enrollment ID: I20240425000955 |
| Provider Name | Lori Gonzalez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912359456 PECOS PAC ID: 1850731753 Enrollment ID: I20240425001631 |
| Provider Name | Alivia Crowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376291542 PECOS PAC ID: 4789024654 Enrollment ID: I20240425004222 |
| Provider Name | Jennifer M. Eklund |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013679125 PECOS PAC ID: 1557701372 Enrollment ID: I20240426002296 |
| Provider Name | Daniel Harold Wendler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346606878 PECOS PAC ID: 0143660977 Enrollment ID: I20240426002828 |
| Provider Name | Asia Brianna Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356035646 PECOS PAC ID: 3779923529 Enrollment ID: I20240426003406 |
| Provider Name | Hannah Springer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558860114 PECOS PAC ID: 1850731605 Enrollment ID: I20240426003429 |
| Provider Name | Michael Azarani |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972295202 PECOS PAC ID: 4183064876 Enrollment ID: I20240429001122 |
| Provider Name | Carly Blake Shannon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407001258 PECOS PAC ID: 7517307267 Enrollment ID: I20240429003402 |
| Provider Name | Darcia Clarice Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306288196 PECOS PAC ID: 5597178335 Enrollment ID: I20240430002773 |
| Provider Name | Kate Cotnam |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972189785 PECOS PAC ID: 8527408087 Enrollment ID: I20240501000203 |
| Provider Name | Laurie Gamble |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851030092 PECOS PAC ID: 6709226152 Enrollment ID: I20240501004127 |
| Provider Name | Ashley Monet Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154946382 PECOS PAC ID: 6507206851 Enrollment ID: I20240502004001 |
| Provider Name | Cordell Spears |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518692888 PECOS PAC ID: 4385084649 Enrollment ID: I20240502004169 |
| Provider Name | Ksenia Kopeikin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104058627 PECOS PAC ID: 2961842174 Enrollment ID: I20240503002271 |
| Provider Name | Bethany Jane Frye |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255963955 PECOS PAC ID: 6204277312 Enrollment ID: I20240507002702 |
| Provider Name | Brianna Palma Nicole Reineke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083299739 PECOS PAC ID: 7416398540 Enrollment ID: I20240507003417 |
| Provider Name | Rikki Lynn Treesh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013376458 PECOS PAC ID: 2163863200 Enrollment ID: I20240507003750 |
| Provider Name | Mary Pearson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942731518 PECOS PAC ID: 0446691471 Enrollment ID: I20240508002646 |
| Provider Name | Kathleen Fahrner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477628287 PECOS PAC ID: 9931540804 Enrollment ID: I20240509000362 |
| Provider Name | Tiffany Marie Nicely-williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487220398 PECOS PAC ID: 6507207412 Enrollment ID: I20240509001907 |
| Provider Name | Alicia Solomon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497319958 PECOS PAC ID: 7810338548 Enrollment ID: I20240513003280 |
| Provider Name | Julie Wilding |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114662335 PECOS PAC ID: 9032550777 Enrollment ID: I20240513003557 |
| Provider Name | Kathryn Monsey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235671124 PECOS PAC ID: 7012358757 Enrollment ID: I20240513003657 |
| Provider Name | Aniela Therese Baczewski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689266272 PECOS PAC ID: 4587005186 Enrollment ID: I20240514002434 |
| Provider Name | Sofia Isabel Hernandez-arenas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568242097 PECOS PAC ID: 8325489925 Enrollment ID: I20240514002682 |
| Provider Name | Jamie L Diaz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831418532 PECOS PAC ID: 6204277684 Enrollment ID: I20240516001163 |
| Provider Name | Edwardo Salvador Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750846127 PECOS PAC ID: 4385085620 Enrollment ID: I20240516003700 |
| Provider Name | Patrick Sivils |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972369155 PECOS PAC ID: 0648612879 Enrollment ID: I20240520002927 |
| Provider Name | Jazmin Crookes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467929208 PECOS PAC ID: 4082056171 Enrollment ID: I20240521001564 |
| Provider Name | Whitney Calhoun Bridges |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306445325 PECOS PAC ID: 6406298595 Enrollment ID: I20240521001709 |
| Provider Name | Jarryn Robinson-ellis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1710320882 PECOS PAC ID: 4880036904 Enrollment ID: I20240521002914 |
| Provider Name | Holland Walker Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326314287 PECOS PAC ID: 6204278617 Enrollment ID: I20240530000645 |
| Provider Name | Rachel Morgan Dunlay |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699328708 PECOS PAC ID: 9335681444 Enrollment ID: I20240604004045 |
| Provider Name | Amy Venn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912582511 PECOS PAC ID: 4880136944 Enrollment ID: I20240605001107 |
| Provider Name | Jacqueline House |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1760148084 PECOS PAC ID: 7911449939 Enrollment ID: I20240605004087 |
| Provider Name | Jason Andrew York |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649753633 PECOS PAC ID: 2668914565 Enrollment ID: I20240606003068 |
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