Provider Demographics
NPI:1891344552
Name:AMY BIRCHILL LAVERGNE, M.ED., LMFT-S, LPC-S, PLLC
Entity Type:Organization
Organization Name:AMY BIRCHILL LAVERGNE, M.ED., LMFT-S, LPC-S, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:BIRCHILL LAVERGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LMFT-S, LPC-S
Authorized Official - Phone:713-502-8028
Mailing Address - Street 1:2142 BELVEDERE CT
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2687
Mailing Address - Country:US
Mailing Address - Phone:713-502-8028
Mailing Address - Fax:210-855-0507
Practice Address - Street 1:542 COMAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7629
Practice Address - Country:US
Practice Address - Phone:713-502-8028
Practice Address - Fax:210-855-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)