Provider Demographics
NPI:1245599372
Name:MYERS, AMANDA MARIE (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:MYERS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N GREENVILLE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1202
Mailing Address - Country:US
Mailing Address - Phone:214-547-1318
Mailing Address - Fax:
Practice Address - Street 1:1514 N GREENVILLE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1202
Practice Address - Country:US
Practice Address - Phone:214-547-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional