Provider Demographics
NPI:1730527417
Name:GRUBBS, AMY (LPC PLLC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:LPC PLLC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MARTINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1020 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2660
Mailing Address - Country:US
Mailing Address - Phone:817-320-8091
Mailing Address - Fax:
Practice Address - Street 1:602 STRADA CIR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3201
Practice Address - Country:US
Practice Address - Phone:817-320-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional