Provider Demographics
NPI:1992597009
Name:BROCKENBUSH, AMBER ROSE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:BROCKENBUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19219 SENTERRA LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2627
Mailing Address - Country:US
Mailing Address - Phone:512-415-5882
Mailing Address - Fax:
Practice Address - Street 1:19219 SENTERRA LAKES BLVD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2627
Practice Address - Country:US
Practice Address - Phone:512-415-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health