Provider Demographics
NPI:1760514129
Name:BLACKMON, AMY (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 WEST AVE UNIT 1808
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4774
Mailing Address - Country:US
Mailing Address - Phone:512-350-7621
Mailing Address - Fax:512-366-9951
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE P2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8664
Practice Address - Country:US
Practice Address - Phone:512-350-7621
Practice Address - Fax:737-237-0779
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31510103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist