Provider Demographics
NPI:1073820817
Name:SOISSON, AMANDA (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SOISSON
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17480 DALLAS PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7337
Mailing Address - Country:US
Mailing Address - Phone:214-402-8302
Mailing Address - Fax:972-407-1305
Practice Address - Street 1:4200 SOUTH FWY
Practice Address - Street 2:SUITE 602
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1400
Practice Address - Country:US
Practice Address - Phone:214-402-8302
Practice Address - Fax:817-923-2063
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional