Provider Demographics
NPI:1790399160
Name:SPENCER, AMANDA (PSYD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E LAMAR BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4121
Mailing Address - Country:US
Mailing Address - Phone:936-596-0448
Mailing Address - Fax:
Practice Address - Street 1:612 E LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4121
Practice Address - Country:US
Practice Address - Phone:214-836-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical