Provider Demographics
NPI:1932346889
Name:SMITH, AMANDA C (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2911
Mailing Address - Country:US
Mailing Address - Phone:512-447-4141
Mailing Address - Fax:512-440-4059
Practice Address - Street 1:105 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1247
Practice Address - Country:US
Practice Address - Phone:512-804-3000
Practice Address - Fax:512-323-9544
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198427001Medicaid