Provider Demographics
NPI:1639472491
Name:GERDES, AMANDA KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHLEEN
Last Name:GERDES
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 1:1311 CHISHOLM TRAIL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2969
Mailing Address - Country:US
Mailing Address - Phone:512-658-4934
Mailing Address - Fax:888-674-7374
Practice Address - Street 1:1311 CHISHOLM TRL STE 301
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2969
Practice Address - Country:US
Practice Address - Phone:512-658-4934
Practice Address - Fax:888-674-7374
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63244101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional