Provider Demographics
NPI:1871848200
Name:KRIEG, AMY (LCDC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KRIEG
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 S KIRKWOOD RD APT 2128
Mailing Address - Street 2:
Mailing Address - City:MEADOWS PLACE
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3051
Mailing Address - Country:US
Mailing Address - Phone:832-752-5617
Mailing Address - Fax:
Practice Address - Street 1:12221 S KIRKWOOD RD APT 2128
Practice Address - Street 2:
Practice Address - City:MEADOWS PLACE
Practice Address - State:TX
Practice Address - Zip Code:77477-3051
Practice Address - Country:US
Practice Address - Phone:832-752-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9645101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)