Provider Demographics
NPI:1851028070
Name:BLOUNT, AMY JOY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JOY
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JOY
Other - Last Name:KNUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2214 MICHIGAN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5952
Mailing Address - Country:US
Mailing Address - Phone:817-723-1210
Mailing Address - Fax:
Practice Address - Street 1:2214 MICHIGAN AVE STE F
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5952
Practice Address - Country:US
Practice Address - Phone:817-723-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health