Provider Demographics
NPI:1760188965
Name:ADAMS, AMELIA ROSE (MED, LPC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ROSE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12031 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-8035
Mailing Address - Country:US
Mailing Address - Phone:940-357-1105
Mailing Address - Fax:
Practice Address - Street 1:12031 CENTER DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384
Practice Address - Country:US
Practice Address - Phone:940-357-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90773101Y00000X, 101YP2500X
TX90733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health