Provider Demographics
NPI:1215199658
Name:FAULKNER, AMANDA K (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:FAULKNER
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 1:2007 JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7402
Mailing Address - Country:US
Mailing Address - Phone:940-765-3036
Mailing Address - Fax:
Practice Address - Street 1:2007 JASMINE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7402
Practice Address - Country:US
Practice Address - Phone:940-765-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional