Provider Demographics
NPI:1396109294
Name:FURQUERON, AMY (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:FURQUERON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 RICKETY LN STE E
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1704
Mailing Address - Country:US
Mailing Address - Phone:903-941-2769
Mailing Address - Fax:
Practice Address - Street 1:2003 RICKETY LN STE E
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1704
Practice Address - Country:US
Practice Address - Phone:903-941-2769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68228101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor