Provider Demographics
NPI:1639582117
Name:PEZZOTTI, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PEZZOTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 FM 1626
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3553
Mailing Address - Country:US
Mailing Address - Phone:512-537-9161
Mailing Address - Fax:
Practice Address - Street 1:1715 FM 1626
Practice Address - Street 2:SUITE 103
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3553
Practice Address - Country:US
Practice Address - Phone:512-537-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional