Provider Demographics
NPI:1912771551
Name:NEAL, AMY LYNETTE (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNETTE
Last Name:NEAL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 NAVA
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-5550
Mailing Address - Country:US
Mailing Address - Phone:940-594-7782
Mailing Address - Fax:
Practice Address - Street 1:6914 NAVA
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-5550
Practice Address - Country:US
Practice Address - Phone:940-594-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional