Healthcare Provider Details

I. General information

NPI: 1134054885
Provider Name (Legal Business Name): OTTER AND ELM MENTAL HEALTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11673 JOLLYVILLE RD STE 201
AUSTIN TX
78759-4211
US

IV. Provider business mailing address

14001 MACQUARIE DR
PFLUGERVILLE TX
78660-6370
US

V. Phone/Fax

Practice location:
  • Phone: 512-909-2041
  • Fax:
Mailing address:
  • Phone: 512-909-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: EMILY BREEDLOVE
Title or Position: OWNER
Credential: MM, MA, LPC
Phone: 512-909-2041