Provider Demographics
NPI:1053935395
Name:SEIDERS, AMY (LMFT, LPC, CCM)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SEIDERS
Suffix:
Gender:F
Credentials:LMFT, LPC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 STONE BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2773
Mailing Address - Country:US
Mailing Address - Phone:817-894-4641
Mailing Address - Fax:
Practice Address - Street 1:2314 STONE BRIDGE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-2773
Practice Address - Country:US
Practice Address - Phone:817-894-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20022101YM0800X
TX5130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health