Provider Demographics
NPI:1558819011
Name:KERLEY, AMANDA (LPC-S)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KERLEY
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MEADOW LEA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6453
Mailing Address - Country:US
Mailing Address - Phone:512-789-9505
Mailing Address - Fax:
Practice Address - Street 1:3625 MANCHACA RD STE 303
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5912
Practice Address - Country:US
Practice Address - Phone:512-789-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67353101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional