Provider Demographics
NPI:1902479181
Name:DURBIN, AMANDA MICHELE (MA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELE
Last Name:DURBIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:MICHELE
Other - Last Name:DURBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMANDA RIEDEL
Mailing Address - Street 1:271 FORT RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODFELLOW AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76908-4901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:271 FORT RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:GOODFELLOW AFB
Practice Address - State:TX
Practice Address - Zip Code:76908-4901
Practice Address - Country:US
Practice Address - Phone:325-654-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810009142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical