Provider Demographics
NPI:1851028070
Name:BLOUNT, AMY JOY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JOY
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JOY
Other - Last Name:KNUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6750 LOCKE AVE STE 102B
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-4196
Mailing Address - Country:US
Mailing Address - Phone:817-207-5112
Mailing Address - Fax:
Practice Address - Street 1:6750 LOCKE AVE STE 102B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-4196
Practice Address - Country:US
Practice Address - Phone:817-207-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health