Provider Demographics
NPI:1659638450
Name:HERRIN, AMY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HERRIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11603 LADERA VISTA DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3998
Mailing Address - Country:US
Mailing Address - Phone:512-496-0192
Mailing Address - Fax:
Practice Address - Street 1:13377 POND SPRINGS RD
Practice Address - Street 2:#107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7152
Practice Address - Country:US
Practice Address - Phone:512-496-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional