Provider Demographics
NPI:1821170028
Name:PERSON, AMY CLAIRE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CLAIRE
Last Name:PERSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 W 6TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5075
Mailing Address - Country:US
Mailing Address - Phone:512-494-9977
Mailing Address - Fax:512-301-0909
Practice Address - Street 1:1613 W 6TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5075
Practice Address - Country:US
Practice Address - Phone:512-494-9977
Practice Address - Fax:512-301-0909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14520101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5369LCOtherBC / BC PROVIDER NUMBER