Provider Demographics
NPI:1740565399
Name:EBNER, AMANDA A (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:EBNER
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 1:7 WINDY KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3843
Mailing Address - Country:US
Mailing Address - Phone:469-223-2748
Mailing Address - Fax:682-885-3936
Practice Address - Street 1:901 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2722
Practice Address - Country:US
Practice Address - Phone:682-885-3587
Practice Address - Fax:682-885-7572
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional