Provider Demographics
NPI:1649573916
Name:WAY, AMANDA C (MLS, LBSW, LCPAA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:WAY
Suffix:
Gender:F
Credentials:MLS, LBSW, LCPAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 NORTHBROOK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5077
Mailing Address - Country:US
Mailing Address - Phone:210-494-2160
Mailing Address - Fax:210-490-7926
Practice Address - Street 1:14400 NORTHBROOK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5077
Practice Address - Country:US
Practice Address - Phone:210-494-2160
Practice Address - Fax:210-490-7926
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37502171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator