Provider Demographics
NPI:1942951181
Name:BERNAL, AMANDA YOLANDA (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:YOLANDA
Last Name:BERNAL
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 1:3712 WICHITA ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-2866
Mailing Address - Country:US
Mailing Address - Phone:817-886-7124
Mailing Address - Fax:
Practice Address - Street 1:3712 WICHITA ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-2866
Practice Address - Country:US
Practice Address - Phone:817-886-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional