Provider Demographics
NPI:1780240150
Name:LIEBERG, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LIEBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PENDERGAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13625 POND SPRINGS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-4400
Mailing Address - Country:US
Mailing Address - Phone:512-537-1415
Mailing Address - Fax:512-539-0160
Practice Address - Street 1:13625 POND SPRINGS RD STE 108
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-4400
Practice Address - Country:US
Practice Address - Phone:512-537-1415
Practice Address - Fax:512-539-0160
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional