Provider Demographics
NPI:1154488906
Name:VIEREGG, AMANDA P (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:P
Last Name:VIEREGG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 AUSTIN AVE
Mailing Address - Street 2:STE. 1001
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1902
Mailing Address - Country:US
Mailing Address - Phone:254-752-1183
Mailing Address - Fax:254-756-5092
Practice Address - Street 1:900 AUSTIN AVE
Practice Address - Street 2:STE. 1001
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1902
Practice Address - Country:US
Practice Address - Phone:254-752-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82405LOtherBCBS ID NUMBER