| NPI | 1184105587 |
|---|---|
| Former Name | AMY LYNN TICE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 37902) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 37902) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2021-03-10 |