Provider Demographics
NPI:1922395730
Name:GLOVER, AMANDA GAYLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:GAYLE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1333 W MCDERMOTT DR
Mailing Address - Street 2:STE. 150
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3090
Mailing Address - Country:US
Mailing Address - Phone:469-519-2782
Mailing Address - Fax:866-433-3741
Practice Address - Street 1:1333 W MCDERMOTT DR
Practice Address - Street 2:150
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3090
Practice Address - Country:US
Practice Address - Phone:469-519-2782
Practice Address - Fax:866-433-3741
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX34158103T00000X
AL1875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist