Provider Demographics
NPI:1649351867
Name:AMIN, NISHA (PHD)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 HIGHWAY 69 S
Mailing Address - Street 2:#620
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-1244
Mailing Address - Country:US
Mailing Address - Phone:409-724-7855
Mailing Address - Fax:409-724-1495
Practice Address - Street 1:2300 HIGHWAY 365
Practice Address - Street 2:#620
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6256
Practice Address - Country:US
Practice Address - Phone:409-724-7855
Practice Address - Fax:409-724-1495
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30550103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3096OtherMEDICARE PROVIDER ID #