Provider Demographics
NPI:1508258096
Name:TAMI, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 RIO GRANDE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1124
Mailing Address - Country:US
Mailing Address - Phone:512-732-8400
Mailing Address - Fax:512-732-8353
Practice Address - Street 1:1700 RIO GRANDE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1124
Practice Address - Country:US
Practice Address - Phone:512-732-8400
Practice Address - Fax:512-732-8353
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71230101YP2500X
TX1982103K00000X
1-14-17650103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional