Provider Demographics
NPI:1922649334
Name:RICHTER, AMANDA RAE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:RICHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GRAHAM DR APT 1513
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6468
Mailing Address - Country:US
Mailing Address - Phone:832-492-7894
Mailing Address - Fax:
Practice Address - Street 1:17030 NANES DR STE 209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2533
Practice Address - Country:US
Practice Address - Phone:832-392-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37629103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist