Provider Demographics
NPI:1497260822
Name:ANDERSON, AMY E (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 WOODLAND RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-8341
Mailing Address - Country:US
Mailing Address - Phone:210-422-4077
Mailing Address - Fax:830-890-5151
Practice Address - Street 1:407 W WATER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4243
Practice Address - Country:US
Practice Address - Phone:210-422-4077
Practice Address - Fax:830-890-5151
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional