Provider Demographics
NPI:1710257852
Name:DURAN, AMANDA (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DURAN
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 1:7300 BLANCO RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:210-279-4626
Mailing Address - Fax:210-247-9315
Practice Address - Street 1:7300 BLANCO RD
Practice Address - Street 2:SUITE 501
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4936
Practice Address - Country:US
Practice Address - Phone:210-279-4626
Practice Address - Fax:210-247-9315
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional