Provider Demographics
NPI:1578682688
Name:AMANAMBU, AUSTIN (LPC)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:AMANAMBU
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3668 MORENCI RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-1636
Mailing Address - Country:US
Mailing Address - Phone:915-204-5463
Mailing Address - Fax:
Practice Address - Street 1:1600 N LEE TREVINO DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5169
Practice Address - Country:US
Practice Address - Phone:915-542-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional