Amy A Kipp, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

202277 Issued in TX

Practice address

11467 Huebner Rd Ste 251
San Antonio, TX 78230-1073

Phone

(503) 389-5504

NPI assigned

Jul 19, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 23, 2024 through Jan 23, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Evergreen Counseling Sa, PLLC

  • Marriage & Family Therapist
  • San Antonio, TX
  • NPI 1063076859
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1255686812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11467 HUEBNER RD STE 251",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782301073",
            "telephone_number": "503-389-5504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11467 HUEBNER RD STE 251",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782301073",
            "telephone_number": "503-389-5504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIPP",
        "first_name": "AMY",
        "middle_name": "A",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-19",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T0879",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "202277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12684503",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dustin Lee Kinzinger, RN
• Leah Kyler Kiolbassa
• Lydell Craig Kiplin, M.D.
• Mark S Kipnes, MD
• Kipp San Antonio College Preparatory Public Schools
• Luissa V Kiprono, D.O.
• Kirby Adult Day Care, Inc.
• Arthur G Kirby II, M.S.,M.DIV.
• Deana Denae Kirby, MA, BCC
• Frank George Kirby Jr., LCSW

• Marriage & Family Therapist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Marriage & Family Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.