Provider Demographics
NPI:1508106188
Name:MARR, AIMEE DEIDRE (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:DEIDRE
Last Name:MARR
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 SW GREEN OAKS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1151
Mailing Address - Country:US
Mailing Address - Phone:817-478-0855
Mailing Address - Fax:817-478-6526
Practice Address - Street 1:5620 SW GREEN OAKS BLVD STE D
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1151
Practice Address - Country:US
Practice Address - Phone:817-478-0855
Practice Address - Fax:817-478-6526
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional