Provider Demographics
NPI:1487927174
Name:ALLAIN, AMIE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:AMIE
Middle Name:MARIE
Last Name:ALLAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:AMIE
Other - Middle Name:MARIE
Other - Last Name:JEFFRYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7019 BACKLICK CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3903
Mailing Address - Country:US
Mailing Address - Phone:281-217-2505
Mailing Address - Fax:
Practice Address - Street 1:2316 TIMBER SHADOWS DR,
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4200
Practice Address - Country:US
Practice Address - Phone:281-217-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36993103TC0700X, 103TC2200X
LA1143103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent