Organization
DEEP EDDY PSYCHOTHERAPY MANAGEMENT, LLC
Active
Organization
DEEP EDDY PSYCHOTHERAPY MANAGEMENT, LLC
Active
Other names
Deep Eddy Psychotherapy, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN R. OLDS PH.D. (MANAGING PSYCHOLOGIST)
(512) 217-9579
Entity
Organization
Contact information
Practice address
508 DEEP EDDY AVE., AUSTIN, TX 78703
(512) 956-6463
(512) 428-8100
Mailing address
508 DEEP EDDY AVE., AUSTIN, TX 78703
(512) 461-0239
(512) 428-8100
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
21274
TX
103TC1900X
Counseling Psychologist
20938
TX
103TC1900X
Counseling Psychologist
33076
TX
103TC1900X
Counseling Psychologist
34301
TX
103TC1900X
Counseling Psychologist
Primary
34890
TX
Other
Enumeration date
01/22/2015
Last updated
12/27/2022
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