=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952595886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NISHA AMIN, PH.D., P.L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2007
-----------------------------------------------------
Last Update Date | 12/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4909 HIGHWAY 69 S
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77705-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-724-0370
-----------------------------------------------------
Fax | 409-724-0375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4909 HIGHWAY 69 S
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77705-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-724-0370
-----------------------------------------------------
Fax | 409-724-0375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | NISHA AMIN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 409-724-0370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 30550
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------