Provider Demographics
NPI:1346850062
Name:GEILENFELDT, AMANDA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:GEILENFELDT
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 1:1613 LARRY WADKINS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5218
Mailing Address - Country:US
Mailing Address - Phone:505-228-6489
Mailing Address - Fax:
Practice Address - Street 1:1613 LARRY WADKINS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5218
Practice Address - Country:US
Practice Address - Phone:505-228-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty