MEDICARE: AMANDA SIEG LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	72617	TX

General Provider Information

NPI Number	:	1427519545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SIEG LPC

Provider Business Mailing Address
First Line	:	5924 LAKESIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-6612
Country	:	US
Telephone Number	:	817-668-0513
Fax Number	:

Provider Business Practice Location Address
First Line	:	5924 LAKESIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-6612
Country	:	US
Telephone Number	:	817-668-0513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	03/28/2022

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