Provider Demographics
NPI:1790901130
Name:BERNOSKI, AMY KRISTINE (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTINE
Last Name:BERNOSKI
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 1:1208 RHONDSTAT RUN
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1650
Mailing Address - Country:US
Mailing Address - Phone:817-695-4586
Mailing Address - Fax:888-335-3416
Practice Address - Street 1:12871 RESEARCH BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3248
Practice Address - Country:US
Practice Address - Phone:512-695-4586
Practice Address - Fax:888-335-3416
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional