Provider Demographics
NPI:1235129008
Name:WARD, AMANDA R (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:WARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1405 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4322
Mailing Address - Country:US
Mailing Address - Phone:469-233-9520
Mailing Address - Fax:
Practice Address - Street 1:101 W MCDERMOTT DR
Practice Address - Street 2:SUITE 111
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2751
Practice Address - Country:US
Practice Address - Phone:469-233-9520
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional