Provider Demographics
NPI:1720095029
Name:AMOS, NANCY NOTLEY (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:NOTLEY
Last Name:AMOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 WEST PLANO PARKWAY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:972-578-9656
Mailing Address - Fax:972-578-8397
Practice Address - Street 1:1721 W PLANO PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8634
Practice Address - Country:US
Practice Address - Phone:972-578-9656
Practice Address - Fax:972-578-8397
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9521101YP2500X
TX1223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3526LCOtherBC/BS OF TETXAS