Provider Demographics
NPI:1154628014
Name:WOOTEN, AMY THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:THOMAS
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 OLD SAN ANTONIO RD STE 505
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3492
Mailing Address - Country:US
Mailing Address - Phone:830-268-4042
Mailing Address - Fax:
Practice Address - Street 1:217 STARKEY ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4255
Practice Address - Country:US
Practice Address - Phone:830-895-1839
Practice Address - Fax:830-895-1839
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical