Provider Demographics
NPI:1932604691
Name:AMDAHL, LUC
Entity Type:Individual
Prefix:
First Name:LUC
Middle Name:
Last Name:AMDAHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N MOPAC EXPY STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3093
Mailing Address - Country:US
Mailing Address - Phone:512-200-9432
Mailing Address - Fax:844-708-1275
Practice Address - Street 1:7000 N MOPAC EXPY STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3093
Practice Address - Country:US
Practice Address - Phone:512-200-9432
Practice Address - Fax:844-708-1275
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT50732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program