Provider Demographics
NPI:1598075434
Name:KRELLER-KOCHIS, AMY MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:KRELLER-KOCHIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:KRELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:8212 ITHACA AVE
Mailing Address - Street 2:SUITE E-10
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2632
Mailing Address - Country:US
Mailing Address - Phone:806-239-9680
Mailing Address - Fax:
Practice Address - Street 1:8212 ITHACA AVE
Practice Address - Street 2:SUITE E-10
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2632
Practice Address - Country:US
Practice Address - Phone:806-239-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional