Provider Demographics
NPI:1164261640
Name:MARTIN, AMBER SHEA (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:SHEA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:SHEA
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9529 CHASEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-7403
Mailing Address - Country:US
Mailing Address - Phone:480-570-4785
Mailing Address - Fax:
Practice Address - Street 1:9529 CHASEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-7403
Practice Address - Country:US
Practice Address - Phone:480-570-4785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical