MEDICARE: CRYSTAL NICOLE DEEDS

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	101YM0800X	Mental Health Counselor	101830	TX

General Provider Information

NPI Number	:	1366375305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL NICOLE DEEDS

Provider Business Mailing Address
First Line	:	8913 BRIDGEWOOD TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-3612
Country	:	US
Telephone Number	:	480-815-3247
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 GRACE LN STE L100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-4833
Country	:	US
Telephone Number	:	480-815-3247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ CRYSTAL NICOLE DEEDS ” Practice Location

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