Provider Demographics
NPI:1811728140
Name:CUNNINGHAM, AMANDA LORENE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LORENE
Last Name:CUNNINGHAM
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 1:11903 EDWARD CONRAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5091
Mailing Address - Country:US
Mailing Address - Phone:210-410-5987
Mailing Address - Fax:
Practice Address - Street 1:11903 EDWARD CONRAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5091
Practice Address - Country:US
Practice Address - Phone:210-410-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician