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123 Blue Heron Dr Ste 104 Montgomery TX 77316-3192 | |
| (936) 449-8053 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 123 Blue Heron Dr Ste 104, Montgomery, Texas |
| Authorized Official Name and Position | Amy R Dean (OWNER) |
| Authorized Official Contact | 9364498053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
123 Blue Heron Dr Ste 104 Montgomery TX 77316-3192 Ph: (936) 449-8053 | 123 Blue Heron Dr Ste 104 Montgomery TX 77316-3192 Ph: (936) 449-8053 |
| NPI Number | 1750817888 |
|---|---|
| Provider Enumeration Date | 05/10/2017 |
| Last Update Date | 11/09/2020 |
| Certification Date | 09/15/2020 |
| Medicare PECOS PAC ID | 4789026543 |
|---|---|
| Medicare Enrollment ID | O20240524000092 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750817888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 202885 (Texas) | Primary |
| Provider Name | Angel Delarosa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962897165 PECOS PAC ID: 9537502521 Enrollment ID: I20240206004948 |
| Provider Name | Amy R Dean |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740713361 PECOS PAC ID: 8224470083 Enrollment ID: I20240524000122 |
| Provider Name | Tiffany Kaye Stout |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346828555 PECOS PAC ID: 9335682053 Enrollment ID: I20240621001770 |
| Provider Name | Aimee Castillo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689379216 PECOS PAC ID: 7517401029 Enrollment ID: I20240625004183 |
| Provider Name | Lisa Lee Vanderpool |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568070886 PECOS PAC ID: 8325584535 Enrollment ID: I20240724002114 |
| Provider Name | Shayla Noel Schmidt |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275131609 PECOS PAC ID: 2769929686 Enrollment ID: I20240808003062 |
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