Provider Demographics
NPI:1598279044
Name:AMMERMAN, AMY LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:AMMERMAN
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 1:1717 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1818
Mailing Address - Country:US
Mailing Address - Phone:713-824-6771
Mailing Address - Fax:
Practice Address - Street 1:2040 NORTH LOOP W STE 390
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8114
Practice Address - Country:US
Practice Address - Phone:713-588-9789
Practice Address - Fax:713-588-9789
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health