Healthcare Provider Details

I. General information

NPI: 1447819958
Provider Name (Legal Business Name): AMBER FAY KOTZUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2019
Last Update Date: 06/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DAVID WADE DRIVE
VICTORIA TX
77905
US

IV. Provider business mailing address

P.O. BOX 2666 ROSIE TATUM
VICTORIA TX
77902
US

V. Phone/Fax

Practice location:
  • Phone: 361-574-7216
  • Fax: 361-575-6520
Mailing address:
  • Phone: 361-574-7216
  • Fax: 361-575-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number80803
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: