Provider Demographics
NPI:1093191330
Name:AMY J ASTON LCSW PC
Entity Type:Organization
Organization Name:AMY J ASTON LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ASTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-579-1606
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-0579
Mailing Address - Country:US
Mailing Address - Phone:817-579-1606
Mailing Address - Fax:817-579-1654
Practice Address - Street 1:416 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1958
Practice Address - Country:US
Practice Address - Phone:817-579-1606
Practice Address - Fax:817-579-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196948703Medicaid
TX196948703Medicaid