Provider Demographics
NPI:1912728908
Name:SIMON O'BRIEN, AMY SUE (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUE
Last Name:SIMON O'BRIEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20906 S AMBER WILLOW TRL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5999
Mailing Address - Country:US
Mailing Address - Phone:770-807-9156
Mailing Address - Fax:
Practice Address - Street 1:20906 S AMBER WILLOW TRL
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5999
Practice Address - Country:US
Practice Address - Phone:770-807-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical