Provider Demographics
NPI:1700384369
Name:STANLEY, AMANDA MICHAELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MICHAELE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 NICKLAUS AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5863
Mailing Address - Country:US
Mailing Address - Phone:832-858-3133
Mailing Address - Fax:
Practice Address - Street 1:7859 WALNUT HILL LN STE 350
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-5618
Practice Address - Country:US
Practice Address - Phone:214-824-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37626103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist