MEDICARE: HEALING HAVEN PSYCHOTHERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1427911015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HAVEN PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	7870 HIGHWAY 290 W APT 9302
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-2962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2204 WESTERN TRAILS BLVD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1641
Country	:	US
Telephone Number	:	737-231-1507
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. DOREEN FRIMPONG-BRAGO
Credential	:	PSYD
Telephone Number	:	737-231-1507

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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