Provider Demographics
NPI:1477329753
Name:AMANDA IBANEZ COUNSELING
Entity Type:Organization
Organization Name:AMANDA IBANEZ COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:IBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:254-722-6958
Mailing Address - Street 1:605 AUSTIN AVE STE 4-105
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-2050
Mailing Address - Country:US
Mailing Address - Phone:254-718-6013
Mailing Address - Fax:
Practice Address - Street 1:605 AUSTIN AVE STE 4-105
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-2050
Practice Address - Country:US
Practice Address - Phone:254-718-6013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty