Provider Demographics
NPI:1629853825
Name:DEEP CENTERED PSYCHIATRY PLLC
Entity type:Organization
Organization Name:DEEP CENTERED PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKUBEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-528-8173
Mailing Address - Street 1:508 DEEP EDDY AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4555
Mailing Address - Country:US
Mailing Address - Phone:972-528-8173
Mailing Address - Fax:
Practice Address - Street 1:508 DEEP EDDY AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4555
Practice Address - Country:US
Practice Address - Phone:972-528-8173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty