Provider Demographics
NPI:1417739186
Name:THIRD COAST PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:THIRD COAST PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EIERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-534-4341
Mailing Address - Street 1:1913 W 19TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-7115
Mailing Address - Country:US
Mailing Address - Phone:231-534-4341
Mailing Address - Fax:
Practice Address - Street 1:1913 W 19TH ST APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-7115
Practice Address - Country:US
Practice Address - Phone:231-534-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty