Provider Demographics
NPI:1326762584
Name:KEITH, AMBER (LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:361-677-1587
Mailing Address - Fax:
Practice Address - Street 1:1024 STEPHENS AVE APT 2
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3864
Practice Address - Country:US
Practice Address - Phone:361-677-1587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional