Provider Demographics
NPI:1740713361
Name:DEAN, AMY R (LMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:DEAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RICHARDS
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:123 BLUE HERON DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-3192
Mailing Address - Country:US
Mailing Address - Phone:913-953-7171
Mailing Address - Fax:
Practice Address - Street 1:123 BLUE HERON DR STE 104
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-3192
Practice Address - Country:US
Practice Address - Phone:936-449-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist