Provider Demographics
NPI:1013256312
Name:BROWN, AMY G (LP, LSSP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:BROWN
Suffix:
Gender:F
Credentials:LP, LSSP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:G
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP, LSSP
Mailing Address - Street 1:13785 RESEARCH BLVD
Mailing Address - Street 2:125
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1873
Mailing Address - Country:US
Mailing Address - Phone:512-238-3042
Mailing Address - Fax:512-655-2101
Practice Address - Street 1:13785 RESEARCH BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1873
Practice Address - Country:US
Practice Address - Phone:512-238-3042
Practice Address - Fax:512-655-2101
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36123103T00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent