Provider Demographics
NPI:1679025399
Name:DAUB, AMANDA JOANN (MA,LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOANN
Last Name:DAUB
Suffix:
Gender:F
Credentials:MA,LPC, LMFT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:JOANN
Other - Last Name:BURK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, LMFT
Mailing Address - Street 1:4422 PACK SADDLE PASS STE 203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1644
Mailing Address - Country:US
Mailing Address - Phone:512-309-0339
Mailing Address - Fax:
Practice Address - Street 1:4422 PACK SADDLE PASS STE 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1644
Practice Address - Country:US
Practice Address - Phone:512-309-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72818101YP2500X
TX202285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional