Provider Demographics
NPI:1922154004
Name:AMISS, RICHARD (LPC, NCC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:AMISS
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:MENARD
Mailing Address - State:TX
Mailing Address - Zip Code:76859-0669
Mailing Address - Country:US
Mailing Address - Phone:325-869-5500
Mailing Address - Fax:830-992-3724
Practice Address - Street 1:1426 E MAIN ST STE 300-400
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5308
Practice Address - Country:US
Practice Address - Phone:830-992-3725
Practice Address - Fax:830-992-3724
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028672602Medicaid