Provider Demographics
NPI:1386161750
Name:PELLER, JESSICA A (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:PELLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9701 BRODIE LN STE 205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6284
Mailing Address - Country:US
Mailing Address - Phone:512-420-8444
Mailing Address - Fax:512-233-2961
Practice Address - Street 1:9701 BRODIE LN STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6284
Practice Address - Country:US
Practice Address - Phone:512-420-8444
Practice Address - Fax:512-233-2961
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37503103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical