Provider Demographics
NPI:1447819958
Name:KOTZUR, AMBER FAY (LPC)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:FAY
Last Name:KOTZUR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2666
Mailing Address - Street 2:ROSIE TATUM
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77902
Mailing Address - Country:US
Mailing Address - Phone:361-574-7216
Mailing Address - Fax:361-575-6520
Practice Address - Street 1:120 DAVID WADE DRIVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77905
Practice Address - Country:US
Practice Address - Phone:361-574-7216
Practice Address - Fax:361-575-6520
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health