Provider Demographics
NPI:1609559087
Name:PERMENTER, EMILY MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:PERMENTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 S WESTERN ST # 19703
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6192
Mailing Address - Country:US
Mailing Address - Phone:303-437-2714
Mailing Address - Fax:
Practice Address - Street 1:5000 S WESTERN ST # 19703
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6192
Practice Address - Country:US
Practice Address - Phone:303-437-2714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty