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General NPI Number Information
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NPI Number | 1760514129
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Entity Type | Individual
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Provider Name | AMY BLACKMON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 4131 SPICEWOOD SPRINGS RD STE P2
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City | AUSTIN
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State | TX
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Zip | 78759-8664
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Country | US
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Telephone | 512-350-7621
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Fax | 737-237-0779
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Provider Business Mailing Address
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Address Line | 301 WEST AVE UNIT 1808
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City | AUSTIN
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State | TX
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Zip | 78701-4774
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Country | US
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Telephone | 512-350-7621
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Fax | 512-366-9951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 31510
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31510
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License Number State | TX
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