=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073805750
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY DELL CARR LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 08/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7905 SAN FELIPE BLVD # 216
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78729-7987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-360-4236
-----------------------------------------------------
Fax | 512-597-4629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2101 34TH ST
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79411-1739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-360-4236
-----------------------------------------------------
Fax | 806-568-2316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 53253
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 53253
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------